Alicam - how much and is anyone using them?

RE: Alicam - how much and is anyone using them?

Andrew Kent — Thu, 02 Feb 2017 17:18:05 GMT

I'm yet to be convinced (nor do I think there is currently any evidence) that this is anything more than a gimmick for most cases. And I think that many of the claims made in the advertising are wildly optimistic.

There was an explosion of these devices in human medicine 5-10 years ago and I have trialled some of those systems. However the limitation of tissue sampling has meant that the use in people has become less and less to the point that they now have only a very specific indication of trying to identify the source of unlocalisable GI bleeding that is outside the reach of endoscopy.

In truth these devices are likely to be even less useful in animals than people as there is almost zero correlation in animals between the gross appearance and the histo diagnosis (which is different to people who have much more ulcerogenic diseases). It is in fact the histology that is most significant (alongside exclusion of other disease with ultrasound etc) in our cases and so there are very few cases where being able to see the inside of the gut is helpful.

I'm sure this is going to be an area of ongoing interest and it may be that evidence appears that supports the use but until those are done I would be wary of spending money on these in 99% of cases.

The cost is relatively high - $450 cost for each device plus $99 for the report afterwards.

It might be a different story if it was half that cost and could therefore be used in addition to other modalities.

I also agree that the Alicam is larger than many of the human devices which does raise concern about the risk of them getting stuck somewhere in a diseased gut.

Just my thoughts on it anyway

Andy

RE: Alicam - how much and is anyone using them?

KMurphy — Thu, 02 Feb 2017 17:15:17 GMT

I've used this in my dog and found it very useful. He's a 25kg English Bull Terrier who had pretty severe vomiting and diarrhoea last year, secondary to NSAIDs.

Pros: Really good image quality, showed us the full extent of his GI ulceration, which was a lot worse than we had suspected. It was easy to give, easy to use. He passed it in 24 hours. We received the report within 24 hours of sending it. The report was excellent, really clear pictures and good advice on treatment etc. No anaesthetic was required - he was really ill so I was happy to not have to do this with him.

It was a much cheaper option than endoscopy. I don't have an endoscope so it also saved me having to arrange time off work to get him to the referral centre!

Cons: It is quite large so I'd be very wary in a small dog. I think they suggest >10kg or so anyway. The dog has to fast for 24 hours before administration and then for a time after administration so poor Ed had no food at all for a full 36hours or so. You don't get a biopsy so if you find a suspicious lesion you'll either need to go to endoscopy or ex-lap to do so. On the plus side of that, at least you know where to look.

All in all, I was very happy with the job it did in my own dog and would be happy to use it again in select cases.

Edit - I'll find the cost price and let you know. I'll see if I can find a way to share Eddie's report on here too, as it was quite interesting.

RE: Alicam - how much and is anyone using them?

Bob Russell — Thu, 02 Feb 2017 17:13:05 GMT

They recommend that owners pick up the poo in a plastic bag and should be able to feel the sensor!!

Owners do not seem to mind doing these things in my experience!

RE: Alicam - how much and is anyone using them?

Rob Davis — Thu, 02 Feb 2017 17:10:45 GMT

[quote user="Anthony Dennison"]I guess you would hospitalise the dog until it's passed...[/quote]

Sounds sensible, but the article in vet times says "Generally, it takes between 3 and 30 hours to pass the single-use capsule, which is recovered by the owner, cleaned, placed in a supplied vial and picked up by courier service...."

RE: Alicam - how much and is anyone using them?

Anthony Dennison — Thu, 02 Feb 2017 16:50:36 GMT

[quote user="Rob Davis"]I think it's usefulness would depend largely on cost (including what is the cost if the owner fails to retrieve it....)[/quote]

I guess you would hospitalise the dog until it's passed...

RE: Alicam - how much and is anyone using them?

Rob Davis — Thu, 02 Feb 2017 16:40:32 GMT

[quote user="Linda Filshie"]A human I know had to have surgery to retrieve it as hers lodged at the site of a stricture[/quote]

At least it found the stricture!

[quote user="Anthony Dennison"]Well, apart from the bit about being able to measure transit time (though you can monitor peristalsis with ultrasound), I'm not sure why endoscopy isn't just as good?[/quote]

Endoscopy can only reach a relatively short proportion of either end of the bowel. I think it's usefulness would depend largely on cost (including what is the cost if the owner fails to retrieve it....)

RE: Alicam - how much and is anyone using them?

Linda Filshie — Thu, 02 Feb 2017 16:33:33 GMT

A human I know had to have surgery to retrieve it as hers lodged at the site of a stricture!

RE: Alicam - how much and is anyone using them?

Anthony Dennison — Thu, 02 Feb 2017 15:47:10 GMT

Well, apart from the bit about being able to measure transit time (though you can monitor peristalsis with ultrasound), I'm not sure why endoscopy isn't just as good? Plus I would be rather nervous giving the ALICAM just in case the dog did chew!!