Retrieval of Retained Wireless Capsule in the Small Bowel in Non-Obstructive Cases Should Be Attempted Via Double Balloon Enterosocopy Before Considering Surgery

Abstract

Purpose: Retained wireless capsule (WC) can lead to small bowel (SB) obstruction. Published surgical opinion recommends surgical intervention be considered in these cases. To our knowledge, no published studies have shown management of retained WC in patients who present with non acute symptoms of SB obstruction. Our hypothesis was that most retained WCs presenting with non-SB acute obstructive symptoms are due to non-malignant causes and can be retrieved using double balloon enteroscopy (DBE). Methods: Retrospective chart review of all DBE cases performed for retained WCs over a period of 6 years. Results: Thirteen patients (12 female, mean age 60.5 years) with 15 retained WCs in the SB were identified, all with non-obstructive symptoms. The duration of retained capsules ranged from 5 days to 13 months (mean 21 weeks). Seventeen DBE were performed by 1 of 4 enteroscopists for the purpose of WC retrieval (see table 1). Fifteen of 16 DBEs were performed as outpatients. WCs were successfully retrieved in 8/12 patients (67%), including 1 patient that required 3 oral DBEs to remove 2 retained WC. Retrieved WCs were located in the mid-distal jejunum (4), mid-ileum (5), and distal ileum (1). WCs were retrieved via a mesh net (6) or a four wire basket (4). SB strictures confirmed in 11/13 patients [diaphragm strictures (8), Crohn's like stricture (2), anastomotic stricture (1)]. All patients with strictures required dilation, except two, with majority up to 15 mm. SB strictures that required dilation were more likely to be encountered during retrograde DBE (p<0.01 by Fisher exact two-tail). Complications occurred in 2 patients (aspiration pneumonia, and SVT requiring cardioversion). Failed procedures were secondary to technical difficulties in patients with Crohn's disease with surgery (1), Crohn's disease without surgery (1), ulcerative colitis post ileo-anal anastomosis (1) and diaphragm strictures (1). In the patient with an ileo-anal anstomosis, both an oral and a retrograde DBE were performed in the same setting, which failed to retrieve 2 retained WCs.Table 1: . No Caption available.Conclusion: Most retained WCs are caused by benign strictures and can be reached by either oral or retrograde DBE after balloon dilations. Retrieval is usually successfully carried out with a mesh net or four wire basket. Crohn's disease and post-operative abdomen pose particular challenges to endoscopic retrieval. Nonetheless, DBE should be the first therapeutic option for these cases.