Can we predict spontaneous capsule passage after retention? A nationwide study to evaluate the incidence and clinical outcomes of capsule retention
J. H. Cheon1
, Y.-S. Kim2
, I.-S. Lee3
, D. K. Chang4
, J.-K. Ryu5
, K. J. Lee6
, J.-S. Moon7
, C. H. Park8
, J.-O. Kim9
, K.-N. Shim10
, C. H. Choi11
, D. Y. Cheung3
, B. I. Jang12
, G.-S. Seo13
, H.-J. Chun2
, M.-G. Choi3
, for the Korean Gut Image Study Group
1Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul; Korea
2Korea University College of Medicine, Seoul; Korea
3Catholic University College of Medicine, Seoul; Korea
4SungKyunkwan University College of Medicine and Samsung Medical Center, Seoul; Korea
5Seoul National University College of Medicine, Seoul; Korea
6Ajou University College of Medicine, Suwon; Korea
7Inje University College of Medicine, Seoul; Korea
8Hallym University College of Medicine, Anyang; Korea
9Soon Chun Hyang University College of Medicine, Seoul; Korea
10Ewha Womans University School of Medicine, Seoul; Korea
11Chung Ang University College of Medicine, Seoul; Korea
12YeungNam University College of Medicine, Daegu; Korea
13Wonkwang University College of Medicine, Iksan; Korea; Korea
Background and study aims: Although capsule endoscopy has become a central diagnostic tool for small-bowel evaluation, retention of a capsule remains a major concern. This study attempted to investigate the incidence and clinical outcomes of capsule retention, and to determine the factors predictive of spontaneous capsule passage after retention.
Patients and methods: Through a nationwide multicenter survey, we retrospectively reviewed the records of 1291 patients who had a capsule endoscopy between February 2002 and July 2006 in Korea. Clinical and procedural characteristics and postprocedural outcomes were analyzed for the cases with capsule retention.
Results: Capsule retention occurred in 2.5 % of total cases (32/1291). The major diseases accompanying capsule retention were Crohn’s disease, malignant tumors, and tuberculous enterocolitis, in decreasing order. In 11 of the 32 patients (34.4 %), early surgical or endoscopic interventions were instituted for diagnosis or treatment of diseases before retention symptoms developed. The remaining 21 (65.6 %) patients initially received medical treatments. Of these, 10 (31.3 %) ultimately underwent surgical intervention due to the development of symptoms of intestinal obstruction or medical treatment failure. The other 11 (34.4 %) eventually passed the capsule. The presence of a larger lumen diameter (greater than two-thirds of the capsule diameter) at the stricture site was associated with spontaneous passage.
Conclusions: Our large-scale study suggests that retention occurs infrequently during capsule endoscopy. Moreover, a retained capsule might indicate the best intervention for the offending pathology, or it may spontaneously pass in the long run, particularly in patients with less small bowel stricture.
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