Risk of Video Capsule Endoscope Retention and the Use of Double Balloon Endoscopy As the Primary Method for Video Capsule Endoscope Retrieval

Abstract

Background and Aims: Capsule retention in the small bowel is a known complication of video capsule endoscopy. Surgery is the most frequently used method of capsule retrieval. The aims of this study were to determine the incidence and causes of capsule retention in a tertiary referral center for small bowel disease and to describe double balloon endoscopy as the primary technique used for capsule retrieval. Patients and Methods: Retrospective analysis of the incidence, causes, management and outcome of capsule retention in 904 video capsule studies performed in a tertiary referral center. Results: Capsule retention occurred in eight patients (incidence: 0.88%; 95% CI: 0.41% - 1.80%), and caused acute small bowel obstruction in six patients. In three of eight patients (37.5%) capsule retention was caused by lymphoma (diffuse large B-cell lymphoma, n=2; enteropathy associated T-cell lymphoma, n=1). In two of eight patients (25%) the cause for capsule retention was small bowel adenocarcinoma. In two of eight patients (25%) capsule retention was caused by postsurgical small bowel changes (blind loop, n=1; ulcerative anastomisis, n=1). One patient had capsule retention due to a Crohn's disease stricture. In this patient a patency capsule had passed without any abnormalities. All retained capsules were successfully removed during double balloon endoscopy. Six patients required elective surgery to treat the underlying cause of capsule retention. Conclusions: In our series, the incidence of capsule retention is low. One case of capsule retention occurred in a patient in whom a patency capsule had passed without abnormalities. Double balloon endoscopy is a safe and reliable method to remove retained capsules. Emergency endoscopy additionally allows tissue-sampling to obtain a diagnosis before elective surgery is performed.