1952 Safety of Capsule Endoscopy During Pregnancy

Abstract

INTRODUCTION: Currently there is limited literature on the safety of Video Capsule Endoscopy (VCE) during pregnancy. There is a theoretical risk of the growing uterus compressing the GI tract. Moreover the gastrointestinal transit is prolonged in the second and third trimester which may jeopardize VCE procedure. We hereby report a case of a pregnant patient who safely underwent a VCE without retention. CASE DESCRIPTION/METHODS: A 30 years old female who was 18 weeks pregnant with a history of myeloproliferative disorder and splenic vein thrombosis presented with hematemesis. She underwent an EGD that demonstrated type 1 isolated gastric varices without active bleeding that was doubted as the source. Colonoscopy found old blood in the terminal Ileum and the ascending colon. She was started on a beta-blocker for variceal bleeding prophylaxis. The patient was informed that there is limited literature on safety of VCE in pregnancy with a theoretical risk of capsule retention. As such pregnancy is deemed a relative contraindication to VCE. Therefore patient decided to pursue clinical monitoring. One week later the patient returned with similar symptoms. During this admission the manufacturer of the capsule was unable to provide any safety data as it had not been studied in pregnant patients. The Obstetrics (OB) service discussed the risks and benefits of VCE during pregnancy. The risk of a retained capsule is that it may require an x-ray of the abdomen and/or surgery. The patient was currently in the 2nd trimester which is the usual recommended trimester for any necessary surgery. Moreover the gestational age was beyond embryogenesis and per ACOG recommendations x-ray should be completed for maternal well-being. Since there were no safer alternatives and maternal wellbeing supersedes fetal health, VCE was performed. It found a small duodenal erosion but otherwise passed into the colon and was a normal examination of the small bowel. Hence recurrent bleeding was attributed to known gastric varices. She is now in her 30th week, following up with OB and per their review the fetus is doing well. She has had no more admissions for gastrointestinal bleeding. DISCUSSION: Elective VCE in pregnant patients should ideally be postponed until after delivery due to a lack of safety data. Nevertheless, VCE may be considered in indications related to maternal symptoms that put the mother or child at risk, such as small bowel bleeding. Accordingly, the FDA has assessed pregnancy as a relative contraindication to VCE.