Small Bowel Video Capsule Endoscopy

Limitations & Potential Complications

Capsule Retention

One of the most significant complications of video CE is capsule retention, which means the capsule remains inside the body for two weeks or more, requiring medical, endoscopical or surgical treatment to remove it. This is an uncommon complication that may happen in approximately 1% of patients,^[2] but, it is a limitation recognized by the International Conference on Capsule Endoscopy.^[30] The retained capsule may not cause any symptoms or result in intestinal obstruction or discomfort.

Capsule retention generally occurs in patients with previous abdominal surgery; for example, patients that have certain diseases, such as Crohn's disease, or patients receiving radiation for GI cancer, such as adenocarcinoma or lymphoma. Capsule retention can also occur in patients using NSAIDs.^[30]

Usually, if the capsule has passed to the colon (according to the images), risk of capsule retention will be insignificant. When the capsule is not sending images from the colon and the patient has not passed the capsule, x-ray can assist to determine the position of the capsule. In a study of 115 patients on this particular issue, 70% of all patients did not see the capsule leave their bodies by day 3. However, by day 14, only three patients (2.6%) were diagnosed with capsule retention. Two underwent surgery and one patient had a small bowel tumor as the cause of his capsule retention. In all three patients, the colon was not visualized on VCE.^[31] In a retrospective review of 1000 VCE procedures at another institution, the rate of retention was 1.4% and three patients had small bowel tumors.^[32] All patients remained 'asymptomatic' from the retained capsules. Thirteen patients underwent elective partial small bowel resection to remove the capsule. It is expected that advances in small bowel enteroscopy will allow the retrieval of retained capsules and that surgery will rarely be required in the future.^[33]

Box 1. Indications and contraindications of video capsule endoscopy.
Indication for small bowel video capsule endoscopy: Obscure gastrointestinal bleeding Crohn's disease Celiac disease Small bowel tumor NSAID enteropathy Screening for polyps Contraindications for video capsule endoscopy: Patients with pacemaker High risk of intestinal obstruction Swallowing difficulties Pregnancy Intestinal pseudo-obstruction Extensive intestinal diverticulosis