Capsule Endoscopy Performed for Small Bowel Obstruction: A Tertiary-Referral Center Experience

Abstract

Purpose: It is suggested that the use of capsule endoscopy (CE) in patients with known or suspected small bowel obstruction is contraindicated. We describe the experience of a tertiary referral center's use of CE for the specific indication of small bowel obstruction. Methods: From November 2003 to May 2007 at the University of North Carolina Hospitals, 54 CE studies were performed for the evaluation of small bowel obstruction in patients whom were being evaluated for operative intervention. We retrospectively reviewed the medical records and CE findings of these patients. Results: The majority of the population was female (57%) and Caucasian (77.8%). The median age (Q1, Q3) was 48.9 years (38.7, 62.0). Most (87%) of the studies were done on an outpatient basis. Approximately 1/3 of patients had inflammatory bowel disease, 68% of which had Crohn's disease. Recent (within 7 days) or ongoing obstruction was the indication for CE in 24% of patients; the remainder done for chronic or recurrent obstruction. The median (Q1, Q3) duration of obstructive symptoms prior to CE was 210 days (60, 1460). Most (75.9%) patients had a history of prior abdominal surgery, 20% had been previously treated with pelvic external beam radiation, and 20% had NSAID use documented at the time of CE. Radiography revealed obstruction in 32 patients (59%) prior to CE, with 24 patients (44%) having obstruction on abdominal CT or small bowel barium study. CE diagnosed potential obstructing lesions in 29 patients (54%), and 25 patients (46%) underwent surgery a median (Q1, Q3) of 20 days following CE (10.5, 55.5). Surgery after CE was diagnostic of an obstructing lesion in 95% of these patients. The capsule reached the cecum in 35% of patients. CE retention occurred in 10 patients (18.5%), with CE removal at surgery in 8 of these (14.8%). There were no perforations, emergent surgeries, or other complications after CE. CE findings agreed with operative assessment of the culprit obstructing lesion in 17 of the 25 patients whom underwent surgery (68%). No preoperative, clinical factors were significantly associated with odds of agreement between CE and surgical findings. Conclusion: CE is safe and effective in selected patients with known or suspected small bowel obstruction, based upon this review of a single tertiary center's experience.