Response:

Abstract

We have reviewed the comments by Drs Kopylov et al1Kopylov U. Yung D.E. Koulaouzidis A. et al.Retention rate in small-bowel capsule endoscopy.Gastrointest Endosc. 2017; 86: 573Scopus (3) Google Scholar regarding our recently published meta-analysis.2Rezapour M. Ahmadi C. Gerson L.B. Retention associated with video capsule endoscopy: systematic review and meta-analysis.Gastrointest Endosc. 2017; 85: 1157-1168.e2Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar The authors raised important points about the use of patency capsules, which are now recommended in current guidelines for patients with inflammatory bowel disease (IBD) before they undergo video capsule endoscopy because of the increased risk of retention in this patient cohort.3Gerson L.B. Fidler J.L. Cave D.R. et al.ACG Clinical Guideline: diagnosis and management of small bowel bleeding.Am J Gastroenterol. 2015; 110: 1265-1287Crossref PubMed Scopus (357) Google Scholar The use of CT enterography (CTE), MR enterography (MRE), or both has also shown similar sensitivity and specificity for small-bowel strictures when compared with the use of the patency capsule.4Yadav A. Heigh R.I. Hara A.K. et al.Performance of the patency capsule compared with nonenteroclysis radiologic examinations in patients with known or suspected intestinal strictures.Gastrointest Endosc. 2011; 74: 834-839Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar However, the use of the patency capsule is limited in the United States because many patients cannot obtain access to centers that perform these studies, do not have insurance coverage for its use, or both; therefore, most patients with potential small-bowel strictures undergo enterography examinations before video capsule endoscopy (VCE). The major concerns raised by the authors regarding our meta-analysis were that the rates calculated for VCE retention in patients with suspected (3.6%) and established (8.2%) IBD might be inaccurate because not all patients underwent patency capsule examinations or CTE first. We had several reasons for the design of our meta-analysis. First, after a thorough literature search, the authors of most studies providing data on VCE retention rates unfortunately had not performed an initial patency capsule study or CTE in the IBD patients. Therefore, had we not included performance of a patency capsule study as an exclusion criterion, we would have been able to analyze a total of only 8 studies for the indication of VCE in IBD patients, resulting in exclusion of the majority of included studies. To reconcile this issue, we decided to exclude primary performance of a patency capsule study in the main analysis of VCE retention in established and suspected IBD patients. However, to the authors’ point, we did perform a subanalysis to include the 8 published studies that provided sufficient information on retention rates in patients with IBD undergoing initial patency capsule examinations or MRE/CTE before VCE. Although the initial retention rate was 12% in this population, subsequent VCE examinations showed that the retention rate was reduced to 2.7%. Because small-bowel patency capsule studies and MRE/CTE have now been integrated as part of the standard evaluation of IBD patients before VCE is performed, we agree that our subanalysis retention rates confirm that VCE can be safely performed in IBD patients, although there still remains a small risk of retention even after both of those studies have been performed. By performance of our meta-analysis, we demonstrated that VCE retention rates could be reduced from 3.6% to 2.7% in patients with suspected IBD and from 8.2% to 2.7% in patients with established IBD. With future anticipated advances in radiographic techniques, we can hope that the detection rate for strictures can be further increased. Dr Gerson is a consultant for Olympus America, Inc., and Capsovision. All other authors disclosed no financial relationships relevant to this publication. Retention rate in small-bowel capsule endoscopyGastrointestinal EndoscopyVol. 86Issue 3PreviewWe read the recent article by Rezapour et al1 with great interest. The authors reported a video capsule endoscopy (VCE) retention rate of 3.6% in suspected inflammatory bowel disease (IBD) and 8.2% in established IBD. However, it appears that the study design precluded the inclusion of several recent publications, which may have shifted the pooled ratios for VCE retention downward. We note that Rezapour et al1 excluded from the main analysis studies in which the patency capsule or cross-sectional imaging was used. Full-Text PDF