Retention of the Capsule Endoscope

Purpose: Capsule endoscopy (CE) permits direct and painless visualization of small bowel mucosa. It has become a powerful imaging modality in evaluating diseases of the small bowel. Retention of the capsule is one of the most significant potential complications. We aimed to determine the incidence and causes of capsule retention and to investigate the clinical outcomes after capsule retention. Methods: A retrospective review of all patients undergoing CE from June 2002- March 2006 was carried out. Demographics, indication for the CE study, causes of retention found on surgery, and post-operative clinical outcomes were extracted. Results: One thousand patients underwent CE for suspected small bowel disease. Eleven patients (1.1%; 1 male, 10 female; average age 60) were found to have radiologically confirmed capsule retentions. The indication for CE was obscure gastrointestinal bleeding in 8 patients and suspected Crohn's disease in 2 patients. One patient underwent CE for evaluation of possible radiation enteritis associated abdominal pain. Eight patients failed to pass the capsule because of small bowel strictures due to NSAID enteropathy (diaphragm disease). Two patients had capsule retention due to obstructing small bowel carcinoid tumors. Metastatic ovarian cancer with invasion of the ileum was the cause of retention in another patient. All patients remained “asymptomatic,” despite retention of the capsules. Ten patients underwent elective partial small bowel resection and capsule removal. No mortality was associated with these surgeries. Two patients developed mild post-op ileus. Conclusions: Capsule retention in clinical practice appears to be low. In most cases, capsule retention is asymptomatic and is unlikely to cause acute obstruction. Capsule retention always occurs at the site of pathology, therefore surgical removal usually leads to identification and treatment of the underlying small bowel disease. Most common cause of retention in our center appears to be diaphragm disease due to NSAIDs followed by small bowel tumors.