Premature dissolution of the Agile patency device: implications for capsule endoscopy

Premature dissolution of the Agile patency device: implications for capsule endoscopy

BackgroundThe main risk of capsule endoscopy is retention of the capsule behind a stricture. Passage of an intact Agile patency device (Medtronic, Dublin, Ireland) through the small bowel is widely used to ensure luminal patency, although capsule retention has occurred in patients who have had a rea...

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Bibliographic Details
Published in:Frontline gastroenterology Vol. 10; no. 3; pp. 217 - 221
Main Authors: Wray, Nicholas, Healy, Ailish, Thurston, Vicky, Hale, Melissa Fay, Sidhu, Reena, Blakeborough, Tony, McAlindon, Mark
Format: Journal Article
Language:English
Published: England BMJ Publishing Group LTD 01-07-2019
BMJ Publishing Group
Series:Original article
Subjects:
Abdomen
Barium
Body piercing
Endoscopy
Gastroenterology
Lactose
Medical imaging
Patients
Retention
Small bowel and Nutrition
Small intestine
Studies
small bowel disease
endoscopy
small bowel enteroscopy
diagnostic and therapeutic endoscopy
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Summary:BackgroundThe main risk of capsule endoscopy is retention of the capsule behind a stricture. Passage of an intact Agile patency device (Medtronic, Dublin, Ireland) through the small bowel is widely used to ensure luminal patency, although capsule retention has occurred in patients who have had a reassuring patency study. The device is designed to remain intact for at least 30 hours postingestion, such that loss of signal from the radiofrequency identification tag contained within, or absence of the device on radiological imaging, implies unimpeded intestinal transit.AimTo identify the rate of premature dissolution (<30 hours postingestion) of the Agile patency device.MethodsOutcomes of all consecutive patients having an Agile patency device were analysed.ResultsPremature dissolution of the patency device occurred in 5 of 307 patients, an incidence of 1.3%. This was recognised by the detection of a persistent radiofrequency signal after radiological imaging had failed to identify the patency device, prompting a careful search for the radiofrequency tag on the CT scout film. The tag was difficult to detect because of an oblique lie making it appear smaller than its 13×3 mm size and confusion with intra-abdominal or other metallic fragments.ConclusionsIn the absence of radiological evidence of an intact Agile patency device, premature dissolution should be suspected in patients registering a persistent radiofrequency signal and confirmed by identifying the radiofrequency identification tag. Failure to do so might result in false reassurance that capsule endoscopy could be performed without risk of retention.
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ISSN:2041-4137
2041-4145
DOI:10.1136/flgastro-2018-101112