Abstract
Background To date, video capsule endoscopy (VCE) is still contraindicated by the FDA and the main manufacturers of Cardiac Implantable Electronic Devices (CIED) in patients with CIED, given a theoretical electromagnetic interference and possible device malfunction. Objectives The objective of this study was to assess the safety profile and efficacy of VCE in patients with implantable cardiac devices through analyzing the risk of mutual interference. Methods A systematic review of PubMed, Web of Science, and Embase databases was conducted. Peer-reviewed original articles, published in the English language and containing “capsule endoscopy” AND “pacemaker”, “defibrillator” OR “left ventricular assist device” as keywords, were selected. Studies performed in vitro, isolated case reports, and abstracts/posters were excluded. Results A total of 735 VCE procedures were performed in patients with cardiac devices in various clinical settings. Cardiac events were not seen in any case. Interference on capsule images transmission was noted in 5 cases (left ventricular assist device (LVAD)) where few images were lost when the capsule was closest to the device. Finally, interference between capsule and telemetry leads was noted in 6 cases (4 Permanent Pacemakers (PPM), 2 Implantable Cardioverter-Defibrillator (ICD)) leading to image artifacts. Discussion Adverse cardiac events were not seen in any study. Loss of images occurred when the VCE was in proximity to the device (only with LVAD) or after telemetry leads installation without affecting the completion rate and diagnostic yield of VCE. Conclusion VCE is safe and remains efficient in patients with cardiac devices. If cardiac monitoring is required, wired systems are preferable.
Highlights
Gastrointestinal bleeding that persists or recurs without any obvious etiology after performing an upper endoscopy and colonoscopy originates from the small bowel (SB) in the majority of cases [1]
video capsule endoscopy (VCE) in patients with Permanent Pacemakers (PPM) or Implantable Cardioverter-Defibrillators (ICD) is still contraindicated according to the last US Food and Drug Administration (FDA) update issued on November 28, 2001, [3] and to the main manufacturers recommendations
Articles published in English language on VCE and implantable cardiac devices from 1/1/04 till 9/1/17 were searched through PubMed, Web of Science, and Embase databases using the keywords (MeSH terms): “video capsule endoscopy” OR “capsule endoscopy” OR “wireless capsule endoscopy” OR “wireless capsule endoscope” OR “capsule endoscope” OR “video capsule endoscope” OR “video capsule”; combined with either: “heart devices”, “pacemaker”; “defibrillator”, “assist device”, or “heart” AND “Interference”
Summary
Gastrointestinal bleeding that persists or recurs without any obvious etiology after performing an upper endoscopy and colonoscopy originates from the small bowel (SB) in the majority of cases [1]. The gold standard test for suspected SB bleeding is video capsule endoscopy (VCE) It was first introduced into clinical practice in 2001 and has emerged given its noninvasiveness and effectiveness as it allows the examination of the entire length of the SB with high quality image acquisition. Video capsule endoscopy (VCE) is still contraindicated by the FDA and the main manufacturers of Cardiac Implantable Electronic Devices (CIED) in patients with CIED, given a theoretical electromagnetic interference and possible device malfunction. The objective of this study was to assess the safety profile and efficacy of VCE in patients with implantable cardiac devices through analyzing the risk of mutual interference. Interference between capsule and telemetry leads was noted in 6 cases (4 Permanent Pacemakers (PPM), 2 Implantable Cardioverter-Defibrillator (ICD)) leading to image artifacts.
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