Predictive Factors of Agile Patency Capsule Retention in Patients Candidates to Capsule Endoscopy

Aims Introduction: Retention is the main complication of capsule endoscopy (CE). The dissolvable Agile Patency Capsule (APC) was developed to asses the functional patency of the small bowel (SB). High-risk patients for retention are those with Crohn’s Disease (CD), history of abdominal radiation therapy (ART), previous small bowel surgery (SBS), suspected strictures based on imaging studies (SSI), obstructive abdominal pain and or chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs)

Aims:

1. To identify predictive factors of APC retention in a cohort of patients eligible for CE.

Secondary aims:

1. To analyze excretion time based on final characteristics of the APC.

2. To describe complications associated with the retention or deformity of the APC.

Methods A retrospective, single-center study was conducted at Hospital Clínic. All patients who underwent APC between September 2010 and April 2024 were included.APC was administered following standard clinical guidelines and the usual APC hospital protocol.

Results A total of 442 patients were included in the analysis. Only 48 of them (10.9%) excreted a deformed APC. The indications for APC were abdominal pain in 108 patients (24.4%), previous SBS in 103 patients (23.3%), CD in 97 patients (21.9%), chronic NSAID use in 75 patients (17%), history of ART in 18 patients (4.1%), and SSI in 41 patients (9.3%). Excretion time for deformed APCs was significantly longer compared to intact APCs (108.16±70.45 hours vs. 41.13±28.35 hours; p<0.005). C-reactive protein (CRP) and fecal calprotectin levels (FC) were higher in cases of deformed APC (CRP: 2.65±0.54 mg/dL vs. 1.42±2.97 mg/dL; p<0.001; FC: 914±777.25 μg/g; p=NS). Univariate analysis showed that SSI and previous ART (p=0.04) were associated with a deformed excretion of APC. However, in multivariate analysis, only previous ART was identified as an independent predictive factor for deformed APC (OR: 3.14; 95% CI: 1.08–9.14; p=0.03). Eleven patients (2.5%) experienced mild, self-limiting nausea and abdominal pain following APC ingestion.

Conclusions Patients with a history of abdominal radiotherapy have a high risk of capsule endoscopy retention, with a threefold increased likelihood of a deformed Agile Patency Capsule excretion. This study emphasizes the importance of strict adherence to APC administration and analysis protocols. Further prospective and multicenter studies are needed.

Publication History

Article published online:
27 March 2025