Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel.
Institute of Gastroenterology, Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.
Dig Dis Sci. 2024 Nov;69(11):4178-4186. doi: 10.1007/s10620-024-08670-9. Epub 2024 Oct 9.
Patency capsule (PC) ingestion is commonly used to minimize capsule retention in high-risk patients with Crohn's disease (CD). However, false-positive rates remain high, precluding the use of video capsule endoscopy (VCE). We aimed to compare the efficacy of two preparation protocols in reducing failed PC rates in patients with CD.
This bi-center retrospective case-control study included adult patients with small-bowel CD in clinical remission who underwent PC ingestion. The pro-motility group followed a low-residue diet, then a clear fluid diet, and took bisacodyl after ingestion, while the control group followed only a clear fluid diet. The primary outcome was failed PC, defined as the absence of PC excretion or presence on abdominal X-ray at 30 h post-ingestion. Multivariable logistic regression was used to identify predictors of failed PC.
Among 273 patients (83 in the pro-motility group, 190 controls), the pro-motility group was older (median 36 [27-48] vs. 31 [24-43], p = 0.012) and had a lower rate of B2/3 disease phenotype (32.5 vs. 53.1%, p = 0.002) compared to controls. The pro-motility group also had a lower failed PC rate (12.0 vs. 24.7%, p = 0.023). Longer disease duration (adjusted odds ratio (AOR) 1.053, 95% confidence interval (CI) 1.016-1.091, p = 0.005) increased the odds of failed PC, while the pro-motility protocol was protective (AOR 0.438, 95% CI 0.200-0.956, p = 0.038), outweighing the influence of B2/3 disease phenotype (AOR 1.743, 95% CI 0.912-3.332, p = 0.093).
The pro-motility preparation protocol could substantially improve the success rates of the small-bowel patency test in patients with CD undergoing PC ingestion, potentially reducing the risk of capsule retention and associated complications.
为了尽量减少克罗恩病（CD）高危患者胶囊滞留，通常使用通透胶囊（PC）吞服。然而，假阳性率仍然很高，这使得视频胶囊内镜（VCE）无法使用。我们旨在比较两种准备方案在降低 CD 患者 PC 失败率方面的效果。
这是一项回顾性的双中心病例对照研究，纳入了处于临床缓解期的小肠 CD 成年患者，他们接受了 PC 吞服。促动力组采用低残留饮食，然后采用清澈液体饮食，并在吞服后服用比沙可啶，而对照组仅采用清澈液体饮食。主要结局是 PC 失败，定义为 30 小时后 PC 未排出或腹部 X 线检查存在 PC。采用多变量逻辑回归来确定 PC 失败的预测因素。
在 273 名患者（促动力组 83 名，对照组 190 名）中，促动力组年龄较大（中位数 36 [27-48] vs. 31 [24-43]，p=0.012），B2/3 疾病表型的发生率较低（32.5% vs. 53.1%，p=0.002）。与对照组相比，促动力组的 PC 失败率也较低（12.0% vs. 24.7%，p=0.023）。较长的疾病病程（调整后的优势比（OR）1.053，95%置信区间（CI）1.016-1.091，p=0.005）增加了 PC 失败的可能性，而促动力方案具有保护作用（OR 0.438，95%CI 0.200-0.956，p=0.038），这超过了 B2/3 疾病表型的影响（OR 1.743，95%CI 0.912-3.332，p=0.093）。
促动力准备方案可显著提高 CD 患者小肠通透试验的成功率，从而降低胶囊滞留和相关并发症的风险。
