Reply to Cebrián et al.

We thank Cebrián et al. for their interest in our study; we agree with the points raised in their letter. Indeed, there is uncertainty regarding the optimal technique to detect the location of the patency capsule [1]. In our study, patency capsule location was verified using the hand-held scanner, plain abdominal film or abdominal computed tomography (CT). A recent, elegant, British study emphasized the inaccuracy of the plain abdominal film for this purpose, and suggested a dedicated low-radiation CT protocol for localization of the patency capsule [2]. This protocol involves a limited number of slices, does not require contrast material, and is associated with a lower level of radiation exposure (0.16 mSv) compared with plain abdominal film (0.4 mSv). In fact, in all patients with a “false-negative” patency capsule test in our study (i. e. excreted the patency capsule but retained the diagnostic capsule), the patency capsule location was verified by a plain abdominal film [3]. It is possible that some of these retention cases could have been avoided if a different modality was used, while enabling additional patients with a “false-positive” patency capsule test to proceed to diagnostic capsule endoscopy safely. Importantly, the accuracy of the hand-held scanner was never directly compared with any imaging modality.

Therefore, we suggest that for patients who do not excrete the patency capsule in due time and in whom the patency capsule was detected by either the hand-held scanner or by plain abdominal film, a low-radiation abdominal CT scan should be performed to ascertain the location of the patency capsule and to guide the decision on whether or not to proceed to a diagnostic video capsule. This approach should be tested prospectively.

• References

• 1 Pennazio M, Spada C, Eliakim R et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352-376
• 2 Assadsangabi A, Blakeborough A, Drew K et al. Small bowel patency assessment using the patency device and a novel targeted (limited radiation) computed tomography-based protocol. J Gastroenterol Hepatol 2015; 30: 984-989
• 3 Nemeth A, Kopylov U, Koulaouzidis A et al. Use of patency capsule in patients with established Crohn’s disease. Endoscopy 2015; DOI: 10.1055/s-0034-1393560.