title: Short article: Negative small-bowel cross-sectional imaging does not exclude capsule retention in high-risk patients.
abstract: OBJECTIVE
  Both Agile patency capsule (PC) and small-bowel cross-sectional imaging (SBCSI) techniques have been used to assess small-bowel patency in patients at high risk of capsule retention. The present study aimed to compare capsule retention rates in high-risk patients with negative PC or SBCSI.
  
  
  METHODS
  Between January 2011 and December 2013, consecutive patients undergoing small-bowel capsule endoscopy (SBCE) in the Lombardia region were prospectively entered into a dedicated registry. They were classified as being at high or low risk of capsule retention by the local investigator according to predefined clinical criteria. High-risk patients underwent either PC or SBCSI depending on local expertise and availability; those who tested negative underwent SBCE.
  
  
  RESULTS
  Out of 3117 patients (male/female: 1667/1450, mean age: 63.1±17.7), 2942 (94.4%) were classified as being at low risk and 175 (5.6%) were classified as being at high risk for capsule retention. Among 175 high-risk patients, 151 (86.3%) had negative PC and 24 (13.7%) had negative SBCSI: capsule retention occurred in two patients with negative SBCSI (8.3%) and in one patient (0.7%) with negative PC (P=0.049). The capsule retention rates in high-risk patients with negative PC and in low-risk patients (20/2942; 0.7%) were comparable (P=1.0).
  
  
  CONCLUSIONS
  The capsule retention rate is similar in low-risk and negative PC high-risk patients. Conversely, high-risk patients with negative SBCSI have a significantly higher capsule retention rate. Our data suggest that in high-risk patients, negative SBCSI examination is not reassuring and, when SBCE is indicated, PC should be performed.
authors.affiliation: aGastroenterology Unit, Valduce Hospital, ComobGastroenterology Unit, S. Carlo Borromeo HospitalcASL Milan 1, Region LombardiadUniversity of Milan, MilaneDepartment of Internal Medicine, Busto Arsizio Hospital, Busto Arsizio, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Rondonotti
authors.forename: Marco
authors.initials: M
authors.lastname: Soncini
authors.forename: Carlo M
authors.initials: CM
authors.lastname: Girelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Russo
authors.forename: Roberto
authors.initials: R
authors.lastname: de Franchis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D053705:Capsule Endoscopes; D053704:Capsule Endoscopy / Q000009:adverse effects* / Q000295:instrumentation; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000473:pathology; D007421:Intestine, Small / Q000000981:diagnostic imaging* / Q000473:pathology; D007558:Italy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed