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should they develop abdominal symptoms post-VCE, as well as recommendations regarding future
potential MRI, may suffice in asymptomatic cases without clear evidence of capsule excretion. In cases of
confirmed Crohn’s disease, perhaps a more cautious approach is wise until further data are available.

In conclusion, a PFA is often requested following small bowel video capsule endoscopy to rule out capsule
retention. This is particularly so in cases where the capsule is not seen to reach the caecum within the
recording window. We question the value of PFA in asymptomatic patients where the capsule is not seen to
pass the ileocaecal valve. In total, 28 cases were identified from a 688 cohort of capsule studies where PFA
was required to exclude capsule retention. No cases of unexpected capsule retention over a five-year period
were identified. No intervention was required in any case. Our data suggest that 14-day PFA may no longer
be required for small bowel capsules not seen to reach the large bowel in asymptomatic cases. Careful
screening of referrals and use of patency capsule and cross-sectional imaging may further reduce the risk of
capsule retention. In the future, larger prospective studies should be considered to further evaluate these
findings and address new guideline implementation.

DECLARATIONS
Authors’ contributions
Study design, data collection, interpretation, and drafting of the manuscript: O’Grady J, Bennett S, Kaar A,
Nolan L, O’Neill J, Quinlivan L, Buckley M

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Approval for this study was granted by the Cork university affiliated hospitals clinical ethics review board
(reference number: ECM 4 (p) 11/5/2021).

Consent for publication
Not applicable.

Copyright
© The Author(s) 2022.

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