MEDICAL NOW No.74 (2013.8)

R/F Current Status and Future Possibilities of Gastrointestinal Tract Patency Evaluation Using Patency Capsules

Dr. Teppei Omori Department of Gastroenterological Medicine, Tokyo Women's Medical University Hospital

Teppei Omori, Shinichi Nakamura, Keiko Shiratori

1. Background and Purpose In Japan, gastrointestinal tract patency evaluations using patency capsules (PC) have been covered by health insurance since July 2012. This has expanded the range of diseases to which capsule endoscopy (CE) is applied. If the PC is not egested from the body, abdominal radiography is used to evaluate gastrointestinal tract patency but in many cases it is difficult to identify the PC position. We have been investigating more accurate PC position evaluation method through PC experience in our hospital. This paper reports on our experiences using PC and on PC position evaluation by tomosynthesis.

2. About CE and PC CE has been used as an examination method for clinical applications for about ten years. In Europe and in the United States, CE for the esophagus and large intestine, in addition to the small intestine, have been marketed and widely applied. Application of CE in Japan is entering its sixth year. Currently marketed capsule endoscopies are designed for the small intestine. Two types of device are used: the PillCam SB Series manufactured by Given Imaging Ltd. and the Olympus endoCapsule. The major features of capsule endoscopy are its low invasiveness and ability to perform safe examinations of the small intestine. However, unlike in overseas, health insurance in Japan had covered only capsule endoscopy of the small intestine in cases of gastrointestinal bleeding of unknown cause. Its use in cases of other diseases had not been allowed. The launch of the PillCam SB2 plus in July 2012 expanded the range of targeted disorders to actual and suspected small intestine diseases in Japan. This permits application to scrutiny of intestinal

lesions in constrictive diseases with the potential for retention, such as definitively diagnosed and suspected Crohn's disease, after the risk of capsule retention—as a complication in capsule endoscopy—is eliminated by evaluating gastrointestinal tract patency using a PillCam Patency Capsule. (Capsule retention is defined as retention of the capsule endoscopy in the body for two weeks or more, which may require surgical intervention.) See Fig. 1.

Fig. 1

3. Intestinal Patency Evaluation The PillCam Patency Capsule (PC) has the same shape as the PillCam SB2 plus, with dimensions of 26 × 11 mm. It is encapsulated in lactose containing 10 % barium sulfate (Fig. 2). The PC is ingested orally. If (1) egestion from the body by defecation is confirmed or (2) abdominal radiography confirms it has reached the large intestine, after 30 to 33 hours without change in shape, the risk of retention of the same-sized PillCam SB2 plus is deemed extremely low, indicating that small intestinal examination by capsule endoscopy is applicable. Approximately 30 hours after ingestion, intestinal juice start to permeate from both ends of the PC, causing it to be dissolved. After about five days,

Dr. Teppei Omori of the Department of Gastroenterological Medicine, Tokyo Women's Medical University Hospital, made a presentation on the Shimadzu SONIALVISION safire Digital R/F System at the 85th general meeting of the Japan Gastroenterological Endoscopy Society (10 to 12 May 2013), entitled "Current Status and Future Possibilities of Gastrointestinal Tract Patency Evaluation Using Patency Capsules." The contents of his presentation are introduced below.

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㻯㼍㼜㼟㼡㼘㼑㻌㻱㼚㼐㼛㼟㼏㼛㼜㼥㻌㼛㼒㻌㼠㼔㼑㻌㻿㼙㼍㼘㼘㻌㻵㼚㼠㼑㼟㼠㼕㼚㼑• 㼂㼕㼑㼣 㼍㼚㼓㼘㼑䠖 㻝㻠㻜㼻• 㻲㼞㼍㼙㼑 㼞㼍㼠㼑䠖 㻞㼒㼞㼍㼙㼑㻛㼟㼑㼏㼼㻜㻚㻜㻢㻑• 㻮㼍㼠㼠㼑㼞㼥 㼛㼜㼑㼞㼍㼠㼕㼚㼓 㼠㼕㼙㼑䠖 㻣㼼㻝 㼔㼛㼡㼞㼟• 㻿㼕㼦㼑䠖 㻸㼑㼚㼓㼠㼔 㻞㻢㼙㼙㻘 㼃㼕㼐㼠㼔 㻝㻝㼙㼙• 㼃㼑㼕㼓㼔㼠䠖 㻟㻚㻠㻡㼓

㻝㼟㼠㻚 㻳㼑㼚㼑㼞㼍㼠㼕㼛㼚 㻯㻱 㻔㻼㼕㼘㼘㼏㼍㼙 㻿㻮㻝㻕

• 㼂㼕㼑㼣 㼍㼚㼓㼘㼑䠖 㻝㻡㻢㼻• 㻲㼞㼍㼙㼑 㼞㼍㼠㼑䠖 㻞㼒㼞㼍㼙㼑㻛㼟㼑㼏㼼㻜㻚㻜㻢㻑• 㻮㼍㼠㼠㼑㼞㼥 㼛㼜㼑㼞㼍㼠㼕㼚㼓 㼠㼕㼙㼑䠖 㼛㼢㼑㼞 㻤 㼔㼛㼡㼞㼟• 㻿㼕㼦㼑䠖 㻸㼑㼚㼓㼠㼔 㻞㻢㼙㼙㻘 㼃㼕㼐㼠㼔 㻝㻝㼙㼙• 㼃㼑㼕㼓㼔㼠䠖 㻞㻚㻥㼓

㻞㼚㼐㻚 㻳㼑㼚㼑㼞㼍㼠㼕㼛㼚 㻯㻱 㻔㻼㼕㼘㼘㼏㼍㼙 㻿㻮㻞㻕

㻲㼞㼛㼙㻌㻞㻜㻜㻣

㻲㼞㼛㼙㻌㻞㻜㻝㻜

㻴㼑㼍㼘㼠㼔㻌㼕㼚㼟㼡㼞㼍㼚㼏㼑㻌㼏㼛㼢㼑㼞㼟㻦㼓㼍㼟㼠㼞㼛㼕㼚㼠㼑㼟㼠㼕㼚㼍㼘㻌㼎㼘㼑㼑㼐㼕㼚㼓㻌㼛㼒㻌㼡㼚㼗㼚㼛㼣㼚㻌㼏㼍㼡㼟㼑

㻴㼑㼍㼘㼠㼔㻌㼕㼚㼟㼡㼞㼍㼚㼏㼑㻌㼏㼛㼢㼑㼞㼟㻦㼓㼍㼟㼠㼞㼛㼕㼚㼠㼑㼟㼠㼕㼚㼍㼘㻌㼎㼘㼑㼑㼐㼕㼚㼓㻌㼛㼒㻌㼡㼚㼗㼚㼛㼣㼚㻌㼏㼍㼡㼟㼑

㻟㼞㼐㻚 㻳㼑㼚㼑㼞㼍㼠㼕㼛㼚 㻯㻱 㻔㻼㼕㼘㼘㼏㼍㼙 㻿㻮㻞㼜㼘㼡㼟㻕 • 㼂㼕㼑㼣 㼍㼚㼓㼘㼑䠖 㻝㻡㻢㼻• 㻲㼞㼍㼙㼑 㼞㼍㼠㼑䠖 㻞㼒㼞㼍㼙㼑㻛㼟㼑㼏㼼㻜㻚㻜㻢㻑• 㻮㼍㼠㼠㼑㼞㼥 㼛㼜㼑㼞㼍㼠㼕㼚㼓 㼠㼕㼙㼑䠖 㼛㼢㼑㼞 㻤 㼔㼛㼡㼞㼟• 㻿㼕㼦㼑䠖 㻸㼑㼚㼓㼠㼔 㻞㻢㼙㼙㻘 㼃㼕㼐㼠㼔 㻝㻝㼙㼙• 㼃㼑㼕㼓㼔㼠䠖 㻞㻚㻥㼓

㻲㼞㼛㼙㻌㻶㼡㼘㼥㻌㻞㻜㻝㻞

㼃㼕㼠㼔 㻼㼕㼘㼘㼏㼍㼙 㼜㼍㼠㼑㼚㼏㼥 㼏㼍㼜㼟㼡㼘㼑

㻲㼞㼛㼙㻌㻶㼡㼘㼥㻌㻞㻜㻝㻞

㻴㼑㼍㼘㼠㼔㻌㼕㼚㼟㼡㼞㼍㼚㼏㼑㻌㼏㼛㼢㼑㼞㼟㻦㼏㼛㼚㼒㼕㼞㼙㼑㼐㻌㼛㼞㻌㼟㼡㼟㼜㼑㼏㼠㼑㼐㻌㼕㼚㼠㼑㼟㼠㼕㼚㼍㼘㻌㼐㼕㼟㼑㼍㼟㼑

㻌㻗㼐㼕㼟㼑㼍㼟㼑㼟㻌㼣㼕㼠㼔㻌㼟㼡㼟㼜㼑㼏㼠㼑㼐㻌㼏㼛㼚㼟㼠㼞㼕㼏㼠㼕㼛㼚

㻔㼕㼚㼏㼘㼡㼐㼕㼚㼓㻌㻯㼞㼛㼔㼚㻓㼟㻌㼐㼕㼟㼑㼍㼟㼑㻕

MEDICAL NOW No.74 (2013.8)

only a thin coating film will remain. This eliminates the risk of PC retention that requires surgical intervention (Fig. 3). However, in the actual clinical practice, it is often difficult to locate the PC position by using abdominal radiography. Fig. 2 Fig. 3

4. Experiences Using PC at This Hospital In the period between July 2012 and the end of November 2012 we used PC to evaluate gastrointestinal tract patency prior to CE in 36 cases (33 cases of Crohn's disease, two cases of suspected small intestinal tumor, and one case of intestinal Behçet's desease). The position could be evaluated visually or by abdominal radiography in 63.9 % of cases. Conversely, positional evaluation (whether in the small intestine or large intestine) by abdominal radiography was difficult in 36.1 % of cases (Fig. 4). Among these clinical cases where evaluation was difficult, in one case which we judged the PC was in large intestine, we experienced CE retention. The actual PC position was the narrowing of the terminal ileum and the CE was retained at this

constriction. In this case, stricture dilation was performed by double-balloon enteroscopy to recover the CE (Fig. 5 and Fig. 6). In cases where the positional evaluation was difficult, the PC tended to be located in the pelvic cavity. At this hospital, we used additional abdominal radiography (lateral or lateral recumbent) and abdominal ultrasonography in such cases but this often did not lead to a definitive judgment of the positions. Fig. 4 Fig. 5 Fig. 6

Purpose: Scrutiny of small intestine lesions

㻱㼢㼍㼘㼡㼍㼠㼕㼛㼚㻌㼛㼒㻌㻳㼍㼟㼠㼞㼛㼕㼚㼠㼑㼟㼠㼕㼚㼍㼘㻌㼀㼞㼍㼏㼠㻌㻼㼍㼠㼑㼚㼏㼥

㻭㼘㼘㻌㼏㼍㼟㼑㼟㻌㼚㼛㼠㻌㼑㼢㼍㼘㼡㼍㼠㼑㼐 㼜㼍㼠㼑㼚㼏㼥㻌㼏㼛㼚㼒㼕㼞㼙㼑㼐㻌㼍㼞㼑㼐㼑㼑㼙㼑㼐㻌㼠㼛 㼔㼍㼢㼑㻌㼚㼛㻌㼜㼍㼠㼑㼚㼏㼥㻚

㻖㻌㻻㼞㼕㼓㼕㼚㼍㼘㻌㼟㼔㼍㼜㼑㻌㻔㻾㼑㼓㼍㼞㼐㼘㼑㼟㼟㻌㼛㼒㻌㼍㼚㼥㻌㼐㼑㼒㼛㼞㼙㼍㼠㼕㼛㼚㻌㼛㼒㻌㼠㼔㼑㻌㻼㼕㼘㼘㻯㼍㼙㼹㻌㻼㼍㼠㼑㼚㼏㼥㻌㻯㼍㼜㼟㼡㼘㼑㻌㼠㼕㼙㼑㼞㻌㼜㼘㼡㼓㻘㻌㼍㻌㻼㼕㼘㼘㻯㼍㼙㼹㻌㻼㼍㼠㼑㼚㼏㼥㻌㻯㼍㼜㼟㼡㼘㼑㻌㻌㻌㼠㼔㼍㼠㻌㼕㼟㻌㼚㼍㼠㼡㼞㼍㼘㼘㼥㻌㼑㼓㼑㼟㼠㼑㼐㻌㼍㼚㼐㻌㼔㼍㼟㻌㼚㼛㻌㼐㼑㼒㼛㼞㼙㼍㼠㼕㼛㼚㻌㼛㼒㻌㼠㼔㼑㻌㼙㼍㼕㼚㻌㼎㼛㼐㼥㻘㻌㼍㼚㼐㻌㼠㼔㼍㼠㻌㼔㼍㼟㻌㼠㼔㼑㻌㼟㼍㼙㼑㻌㼔㼍㼞㼐㼚㼑㼟㼟㻌㼍㼟㻌㼎㼑㼒㼛㼞㼑㻌㼟㼣㼍㼘㼘㼛㼣㼕㼚㼓㻚㻕

㼀㼕㼙㼑㻌㻿㼕㼚㼏㼑㻿㼣㼍㼘㼘㼛㼣㼕㼚㼓㻌㻔㼠㻕㼡㼚㼕㼠㼟㻦㻌㼔㼛㼡㼞㼟

㼂㼕㼟㼡㼍㼘㻔㻱㼓㼑㼟㼠㼕㼛㼚㻕

㻾㼍㼐㼕㼛㼓㼞㼍㼜㼔㼥㻼㼕㼘㼘㻯㼍㼙㼹

㻼㼍㼞㼠㼕㼏㼘㼑㻌㻯㼍㼜㼟㼡㼘㼑㻌㻼㼛㼟㼕㼠㼕㼛㼚㻼㼍㼠㼑㼚㼏㼥

㼀䠘㻟㻜 㻯㼛㼚㼒㼕㼞㼙㼑㼐㻖 䠉 䠉 㼅㼑㼟

㻟㻜䍺㼀䍺㻟㻟

㻯㼛㼚㼒㼕㼞㼙㼑㼐㻖 䠉 䠉 㼅㼑㼟

䠉㻼㼑㼞㼒㼛㼞㼙㼑㼐㻔㼕㼚㻌㼎㼛㼐㼥㻕

㻾㼑㼍㼏㼔㼑㼐㻌㼘㼍㼞㼓㼑㼕㼚㼠㼑㼟㼠㼕㼚㼑

㼅㼑㼟

㻱㼢㼍㼘㼡㼍㼠㼕㼛㼚㻌㻯㼞㼕㼠㼑㼞㼕㼍㻌㼒㼛㼞㻳㼍㼟㼠㼞㼛㼕㼚㼠㼑㼟㼠㼕㼚㼍㼘㻌㼀㼞㼍㼏㼠㻌㻔㻿㼙㼍㼘㼘㻌㻵㼚㼠㼑㼟㼠㼕㼚㼑㻕㻌㻼㼍㼠㼑㼚㼏㼥

㻙㻦㻌㻺㻛㻭

PillCam® Patency Capsule Position

Except for the cases “Confirmed Patency”, all other cases are judged to have no patency.

䠆 Original condition: Disregarding any deformation of the PillCam® Patency Capsule timer plug, the condition that the egested PillCam® Patency Capsule has the same hardness as before swallowing, having no deformation of the main body.

Time Since Swallowing (T)

Units: hours

㻱㼤㼜㼑㼞㼕㼑㼚㼏㼑㼟㻌㼁㼟㼕㼚㼓㻌㻼㻼㻯㻌㼍㼠㻌㼀㼔㼕㼟㻌㻴㼛㼟㼜㼕㼠㼍㼘

㻺㼡㼙㼎㼑㼞㻌㼛㼒㻌㼏㼍㼟㼑㼟㻌㼡㼟㼑㼐㻦㻌㻟㻢㼀㼍㼞㼓㼑㼠㻌㼐㼕㼟㼑㼍㼟㼑㼟㻦㻌㼠㼣㼛㻌㼏㼍㼟㼑㼟㻌㼛㼒㻌㼟㼡㼟㼜㼑㼏㼠㼑㼐㻌㼟㼙㼍㼘㼘㼕㼚㼠㼑㼟㼠㼕㼚㼍㼘㻌㼠㼡㼙㼛㼞㻘㻌㼛㼚㼑㻌㼏㼍㼟㼑㻌㼛㼒㻌㼕㼚㼠㼑㼟㼠㼕㼚㼍㼘㻌㻮㼑㼔㽲㼑㼠㻓㼟㻘㻟㻟㻌㼏㼍㼟㼑㼟㻌㼛㼒㻌㻯㼞㼛㼔㼚㻓㼟㻌㼐㼕㼟㼑㼍㼟㼑㻌㻔㼕㼚㼏㼘㼡㼐㼕㼚㼓㻌㻝㻌㼟㼡㼟㼜㼑㼏㼠㼑㼐㻌㼏㼍㼟㼑㻕

㻹㼑㼠㼔㼛㼐㻌㼛㼒㻌㼍㼐㼙㼕㼚㼕㼟㼠㼞㼍㼠㼕㼛㼚㻦㻌㻝㻡㻌㼙㼓㻌㼙㼛㼟㼍㼜㼞㼕㼐㼑㻌㼏㼕㼠㼞㼍㼠㼑㼕㼚㼓㼑㼟㼠㼑㼐㻌㼛㼞㼍㼘㼘㼥㻌㼍㼠㻌㻤㻌㼍㼙㻘㻌㻼㻼㻯㻌㼕㼚㼓㼑㼟㼠㼑㼐㻌㼍㼠㻌㻥㻌㼍㼙㻌㼛㼚㻌㼠㼔㼑㼐㼍㼥㻌㼎㼑㼒㼛㼞㼑㻌㼏㼍㼜㼟㼡㼘㼑㻌㼑㼚㼐㼛㼟㼏㼛㼜㼥㻘㻌㼣㼔㼕㼘㼑㻌㼒㼍㼟㼠㼕㼚㼓㻚

䊼㻭㼒㼠㼑㼞㻌㻞㻠㻌㼠㼛㻌㻟㻜㻌㼔㼛㼡㼞㼟㻘㻌㼏㼛㼚㼒㼕㼞㼙㼍㼠㼕㼛㼚㼍㼠㻌㼠㼔㼑㻌㼔㼛㼟㼜㼕㼠㼍㼘㻌㼣㼔㼑㼠㼔㼑㼞㻌㼠㼔㼑㻌㻼㻼㻯㻌㼣㼍㼟㻌㼑㼓㼑㼟㼠㼑㼐㻚

㻺㼍㼠㼡㼞㼍㼘㻌㼑㼓㼑㼟㼠㼕㼛㼚㻌㼏㼛㼚㼒㼕㼞㼙㼑㼐

㻼㼛㼟㼕㼠㼕㼛㼚㼍㼘 㼑㼢㼍㼘㼡㼍㼠㼕㼛㼚㼎㼥 㼞㼍㼐㼕㼛㼓㼞㼍㼜㼔㼥 㼐㼕㼒㼒㼕㼏㼡㼘㼠

㻼㼍㼠㼑㼚㼏㼥 㼚㼛㼠 㼏㼛㼚㼒㼕㼞㼙㼑㼐㼎㼥 㼞㼍㼐㼕㼛㼓㼞㼍㼜㼔㼥㻦 㼍㼘㼞㼑㼍㼐㼥 㼑㼓㼑㼟㼠㼑㼐

㻯㼛㼚㼒㼕㼞㼙㼍㼠㼕㼛㼚 㼎㼥 㼞㼍㼐㼕㼛㼓㼞㼍㼜㼔㼥㼠㼔㼍㼠㻌㻼㻼㻯 㼞㼑㼍㼏㼔㼑㼐㻌㼠㼔㼑 㼏㼛㼘㼛㼚

㻔㻶㼡㼘㼥㻌㻞㻜㻝㻞㻌㼠㼛㻌㼑㼚㼐㻌㼛㼒㻌㻺㼛㼢㼑㼙㼎㼑㼞㻌㻞㻜㻝㻞㻕

19.4%

36.1%

8.3%

36.1%

㻼㻼㻯㻌㼏㼛㼚㼒㼕㼞㼙㼑㼐㻌㼜㼍㼠㼑㼚㼏㼥㻌㼕㼚㻌㻢㻟㻚㻥㻌㻑㻌㼏㼍㼟㼑㼟

Experiences Using PC at This Hospital

Number of cases used: 36 Target diseases: two cases of suspected small intestinal tumor, one case of intestinal Behçet's disease, 33 cases of Crohn's disease (including 1 suspected case) Method of administration: 15 mg mosapride citrate ingested orally at 8 am, PC ingested at 9 am on the day before capsule endoscopy, while fasting. 㻌 㻌 㻌 㻌 㻌 䊼 After 24 to 30 hours, confirmation at the hospital whether the PC was egested.

Natural egestion confirmed Confirmation by radiography that PC reached the colon Patency not confirmed by radiography: already egested Difficult positional evaluation by radiography

PC confirmed patency in 63.9 % cases

㼃㼔㼍㼠㻌㼕㼟㻌㼠㼔㼑㻌㻼㼕㼘㼘㻯㼍㼙㼹㻌㻼㼍㼠㼑㼚㼏㼥㻌㻯㼍㼜㼟㼡㼘㼑㻫

㻵㼚㻌㼏㼍㼟㼑㼟㻌㼛㼒㻌㼍㼏㼠㼡㼍㼘 㼛㼞 㼟㼡㼟㼜㼑㼏㼠㼑㼐㻌㼓㼍㼟㼠㼞㼛㼕㼚㼠㼑㼟㼠㼕㼚㼍㼘㻌㼟㼠㼑㼚㼛㼟㼕㼟 㼛㼞 㼚㼍㼞㼞㼛㼣㼕㼚㼓㻘㼠㼔㼑 㻼㼕㼘㼘㻯㼍㼙㼹 㻼㼍㼠㼑㼚㼏㼥㻌㻯㼍㼜㼟㼡㼘㼑 㼏㼍㼚㻌㼎㼑 㼡㼟㼑㼐㻌㼠㼛 㼑㼢㼍㼘㼡㼍㼠㼑 㼓㼍㼟㼠㼞㼛㼕㼚㼠㼑㼟㼠㼕㼚㼍㼘㼜㼍㼠㼑㼚㼏㼥 㼎㼑㼒㼛㼞㼑 㼜㼑㼞㼒㼛㼞㼙㼕㼚㼓 㼏㼍㼜㼟㼡㼘㼑 㼑㼚㼐㼛㼟㼏㼛㼜㼥㻌㼡㼟㼕㼚㼓 㻼㼕㼘㼘㻯㼍㼙㼹 㻿㻮㻞㻌㼜㼘㼡㼟㻚

! 㻲㼑㼍㼠㼡㼞㼑㼟㻌㼛㼒㻌㼠㼔㼑㻌㻼㼕㼘㼘㻯㼍㼙㼹㻌㻼㼍㼠㼑㼚㼏㼥㻌㻯㼍㼜㼟㼡㼘㼑

" 㻿㼍㼙㼑 㼟㼕㼦㼑㻌㼍㼟 㻼㼕㼘㼘㻯㼍㼙㼹 㻿㻮㻞 㼜㼘㼡㼟 㼏㼍㼜㼟㼡㼘㼑

" 㻯㼍㼚㻌㼎㼑㻌㼛㼎㼟㼑㼞㼢㼑㼐㻌㼡㼟㼕㼚㼓㻌㼞㼍㼐㼕㼛㼓㼞㼍㼜㼔㼥

" 㻯㼍㼜㼟㼡㼘㼑㻌㼐㼑㼓㼞㼍㼐㼑㼟

㻼㼕㼘㼘㻯㼍㼙㼹 㻼㼍㼠㼑㼚㼏㼥㻌㻯㼍㼜㼟㼡㼘㼑

䖂 㻯㼍㼜㼟㼡㼘㼑㻌㼑㼓㼑㼟㼠㼑㼐㻌㼕㼚㻌㼛㼞㼕㼓㼕㼚㼍㼘㻌㼟㼔㼍㼜㼑

㻱㼓㼑㼟㼠㼑㼐㻌㼣㼕㼠㼔㻌㼚㼛㻌㼐㼑㼓㼞㼍㼐㼍㼠㼕㼛㼚㻌㼛㼒㻌㼠㼔㼑㻌㼙㼍㼕㼚㻌㼎㼛㼐㼥

㻱㼓㼑㼟㼠㼑㼐㻌㼣㼕㼠㼔㻌㼐㼑㼓㼞㼍㼐㼍㼠㼕㼛㼚㻌㼛㼒㻌㼠㼔㼑㻌㼙㼍㼕㼚㻌㼎㼛㼐㼥

㻯㼛㼙㼜㼘㼑㼠㼑㼘㼥㻌㼐㼑㼓㼞㼍㼐㼑㼐䇵䇵㼛㼚㼘㼥㻌㼠㼔㼑㻌㼏㼛㼍㼠㼕㼚㼓㻌㼒㼕㼘㼙㻌㼕㼟㻌㼑㼓㼑㼟㼠㼑㼐

䕿

㽢

㽢

㻼㼍㼠㼑㼚㼏㼥㼏㼛㼚㼒㼕㼞㼙㼑㼐

㻺㼛㻌㼜㼍㼠㼑㼚㼏㼥

Same size as PillCam® SB2 plus capsule Can be observed using radiography Dissolvable Capsule

䖂 Capsule egested in original shape 䕿 Egested with no dissolved main body 㽢 Egested with dissolved main body 㽢 Completely dissolved––only the coating film is egested

In cases of known or suspected gastrointestinal strictures, the PillCam® Patency Capsule can be used to evaluate gastrointestinal patency prior to administration of the capsule endoscopy PillCam® SB2 plus.

㻯㼘㼕㼚㼕㼏㼍㼘㻌㻯㼍㼟㼑㻌㼃㼔㼑㼞㼑㻌㻼㼛㼟㼕㼠㼕㼛㼚㼍㼘㻌㻱㼢㼍㼘㼡㼍㼠㼕㼛㼚㻌㼃㼍㼟㻌㻰㼕㼒㼒㼕㼏㼡㼘㼠㻟㻥㻙㼥㼑㼍㼞㻙㼛㼘㼐㻌㼒㼑㼙㼍㼘㼑㻰㼕㼍㼓㼚㼛㼟㼕㼟㻦㻌㼟㼙㼍㼘㼘㻌㼕㼚㼠㼑㼟㼠㼕㼚㼍㼘

㻯㼞㼛㼔㼚㻓㼟㻌㼐㼕㼟㼑㼍㼟㼑㻭㼕㼙㻦㻌㻿㼏㼞㼡㼠㼕㼚㼥㻌㼛㼒㻌㼟㼙㼍㼘㼘㻌㻌㻌㻌㻌㻌㻌㼕㼚㼠㼑㼟㼠㼕㼚㼑㻌㼘㼑㼟㼕㼛㼚㼟Purpose: Scrutiny of small

intestine lesions

MEDICAL NOW No.74 (2013.8)

5. Issues of Patency Evaluation by Abdominal Radiography

We believe that the structure of the abdominal cavity is related to the difficulties in identifying the PC position by abdominal radiography. The small and large intestines are compressed within the restricted space inside the abdominal cavity and the morphological information on soft tissues overlaps in abdominal radiographs, making identification of the PC position difficult (Fig. 7 and Fig. 8). Using CT makes positional identification easier but this procedure should not be taken without paying attention to X-ray exposure dose and medical expenditure. Fig.7 Fig.8

6. Patency Evaluation by Tomosynthesis Wondering if slicing up the overlaid morphological information would permit positional evaluation of PCs, we used tomosynthesis on the abdominal soft tissue. One of the cases is introduced here. In the abdominal radiograph, the PC is located on the left side of the pelvis, making positional

evaluation difficult. However, the tomosynthesis images which were taken at almost the same time as radiography showed the path of the colon clearly and the PC was identified in the sigmoid colon (Fig. 9). Other tomosynthesis images show the paths of the ascending, transverse, and descending colons (Fig. 10), suggesting that the PC position should be identified at other locations in the large intestine. Fig. 9

Fig. 10(a) Ascending Colon

Fig. 10(b) Transverse Colon

㻼㼞㼛㼎㼘㼑㼙㼟㻌㼕㼚㻌㻼㼍㼠㼑㼚㼏㼥㻌㻱㼢㼍㼘㼡㼍㼠㼕㼛㼚㻺㼍㼠㼡㼞㼍㼘㻌㼑㼓㼑㼟㼠㼕㼛㼚㻌㼚㼛㼠㻌㼏㼛㼚㼒㼕㼞㼙㼑㼐㻘㼞㼍㼐㼕㼛㼓㼞㼍㼜㼔㼥㻌㼜㼑㼞㼒㼛㼞㼙㼑㼐

㻯㼛㼘㼛㼚 㼀㼑㼞㼙㼕㼚㼍㼘㻌㼕㼘㼑㼡㼙

㻯㼍㼟㼑㻌㻔㻝㻕 㻯㼍㼟㼑㻌㻔㻞㻕

㻼㼘㼍㼕㼚㻌㻾㼍㼐㼕㼛㼓㼞㼍㼜㼔㼥 㼀㼛㼙㼛㼟㼥㼚㼠㼔㼑㼟㼕㼟

㻱㼢㼍㼘㼡㼍㼠㼕㼛㼚㻌㼎㼥㻌㼀㼛㼙㼛㼟㼥㼚㼠㼔㼑㼟㼕㼟

Issues

㼃㼔㼥㻌㼕㼟㻌㻱㼢㼍㼘㼡㼍㼠㼕㼛㼚㻌㼎㼥㻌㻾㼍㼐㼕㼛㼓㼞㼍㼜㼔㼥㻌㻰㼕㼒㼒㼕㼏㼡㼘㼠㻫

㻻㼢㼑㼞㼘㼍㼕㼐㻌㼕㼚㼠㼑㼟㼠㼕㼚㼍㼘㻌㼠㼞㼍㼏㼠㻌㼙㼍㼗㼑㼟㻌㼑㼢㼍㼘㼡㼍㼠㼕㼛㼚㻌㼐㼕㼒㼒㼕㼏㼡㼘㼠㻚

→㻯㼛㼡㼘㼐㻌㼟㼘㼕㼏㼕㼚㼓㻌㼠㼔㼑㻌㼛㼢㼑㼞㼘㼍㼕㼐㻌㼕㼚㼒㼛㼞㼙㼍㼠㼕㼛㼚㻌㼙㼍㼗㼑㻌㼑㼢㼍㼘㼡㼍㼠㼕㼛㼚㻌㼜㼛㼟㼟㼕㼎㼘㼑㻫䊻Could slicing the overlaid information make evaluation easier?

MEDICAL NOW No.74 (2013.8)

Fig. 10(c) Descending Colon

Fig. 10(d) Sigmoid Colon and PC

7. What Is Tomosynthesis? Tomosynthesis takes multiple projection images in a single tomographic imaging operation and applies post-processing to reconstruct section images at the required depths. Tomosynthesis is less invasive; it requires approximately twice the X-ray exposure dose of plain radiography and one-tenth the dose for CT. Tomosynthesis is the promising low dose X-ray imaging method for evaluation of PC locations.

8. Conclusions We reported the current situation and future possibilities for evaluating gastrointestinal tract patency using patency capsules. This is the first report using tomosynthesis for the patency evaluation of PC in gastrointestinal tract, and we will continue further investigations in the future.