CAPSULE RETENTION AND RETRIEVAL

Aims:

Capsule endoscopy (CE) has been widely adopted as a safe and effective method of examining the small bowel. However, capsule retention, reported to affect ˜2% of patients, is a significant procedural complication. The aim of this study was to review the incidence and outcome of patients with capsule retention in a large single centre cohort.

Methods:

All patients undergoing CE between March 2005 and October 2017 were included. Patients with incomplete procedures were reviewed for capsule retention, defined as CE remaining in the digestive tract ≥2 weeks or requiring removal.¹ For these patients data was collected on baseline demographics, indications, capsule design, and the outcome or method of capsule extraction.

Results:

Data from 2058 procedures were reviewed (median age 57.4yrs, F = 57.5%). Indications for CE were anaemia/GI bleeding (n = 1408), inflammatory bowel disease (IBD) (n = 595), SB malignancy (n = 28), others (n = 223). 79 (3.8%) were incomplete; 12 (0.59%) CEs in 11 patients were retained (median age 64.1yrs, F = 66.6%). 3 capsules were excreted without intervention; 9/2058 (0.44%) required removal. Indications in these patients were: anaemia (n = 5), GI bleeding (n = 2), abdominal pain (n = 4), IBD (n = 2). 3/9 (33%) of patients requiring capsule retrieval had Crohn's disease, compared with 595/2058 (28.9%) of the total cohort. 7 were removed endoscopically (4 with double balloon endoscopy and 3 with gastroscopy). 2 required laparotomy. Retention was due to a variety of pathologies: malignancies (n = 2), benign stricturing disease (n = 2), gastric retention (n = 2) and anastomotic retention (n = 3).

Conclusions:

This study shows that capsule retention is rare, affecting 0.59%, and has produced results in keeping with a recent literature². A variety of pathologies, including Crohn's disease, were associated with capsule retention but as 99.56% of capsules passed spontaneously these findings support the safety of CE as a small bowel investigation.