Incidence and Clinical Predictors of Gastric Retention in Video Capsule Endoscopy (VCE)

Abstract

Purpose: VCE is an established technique for examination of the small bowel and has become an important diagnostic tool. The approximate incidence of incomplete small bowel studies due to transit delay is 25%, however, the incidence of gastric retention is not known. Many patients with incomplete studies require a second VCE which often is placed into the small bowel under endoscopic assistance. In this study we sought to assess the incidence of gastric capsule retention in patients undergoing VCE and elucidate specific clinical factors predicting gastric retention in those patients who have had incomplete capsule studies. Methods: We performed a retrospective chart review of 1200 patients undergoing VCE between 2002–2007. Cases had gastric retention of the capsule and controls were patients who had had completed VCE studies. Controls were matched in a 1:1 fashion for age, gender and indication for VCE. Results: There was gastric retention of VCE in 16 patients out of 1200 patients who underwent an initial VCE (1.3%). There was no difference in demographic features between group I and II including race and BMI. There was no difference in gastrointestinal symptoms such as bloating, GERD symptoms, epigastric pain, or nausea/vomiting. Patients with retained VCE did not have increased prevalence of DM or hypothyroidism. There was no difference between the two groups with respects to use of anti-inflammatory, narcotic, prokinetic, antispasmodic, anti-cholinergic and/or anti-secretory medications. A significant proportion of patients in group I had a history of prior gastric or bowel surgery compared to none in group II [56% vs. 0%; P < 0.001]. In 5 of 16 patients a gastric emptying study (GES) was performed and all studies were positive for delayed gastric emptying. After initial gastric retention of VCE, a second VCE was performed in 11/16 patients, 7 of whom underwent EGD-assisted placement of the capsule. In 2/4 cases where EGD assistance was not used there was recurrent gastric retention of capsule. Conclusion: 1. Gastric retention of VCE occurs in approximately 1% of patients undergoing VCE. 2. While there was no significant difference in clinical features nor prescription drug use in cases compared to controls, patients with a history of gastric or bowel surgery and/or delayed gastric emptying on GES are more likely to have gastric retention of VCE. 3. In a patient with prior gastric retention of the video capsule or evidence of delayed gastric emptying on GES, repeat VCE should be done with EGD assistance because of high frequency of recurrence of gastric capsule retention.