S2778 The Dangers of Seeing the Light: Importance of Forward-Facing Orientation for Endoscopic Capsule Deployment

Abstract

INTRODUCTION: Since 2001 video capsule endoscopy (VCE) has been widely applied to assess small bowel bleeding, iron deficiency anemia (IDA), inflammatory bowel disease, refractory celiac disease and polyposis syndromes. Limitations include the inability to intervene, lack of familiarity with reading video and handling software, as well as time required to interpret findings. The aim of this case series is to present 4 cases of lens damage to the VCE from the VCE capsule holder used during endoscopic placement. CASE DESCRIPTION/METHODS: 86 VCE studies were reviewed; 4 showed structural VCE lens damage after endoscopic placement. These were all placed with lens towards the releasing device rather than forward-facing. No signs of lens damage were observed in the remaining 82 capsule studies. The first case was a 60-year-old woman with IDA and normal VCE study. The second patient was an 84-year-old man with IDA, with small ulcerations throughout the small bowel on VCE. Third was a 30-year-old woman with iron deficiency and normal hemoglobin level, with a non-diagnostic VCE. Last was an 89-year-old man with IDA, with VCE showing duodenal polyp. DISCUSSION: Appropriate endoscopic deployment technique involves the use of a catheter-based device to which a cup is attached to hold the capsule, with a moveable metal core that pushes it out of the cup (US Endoscopy, Mentor, Ohio), allowing deployment. The optical dome of the video capsule should be placed in this holder forward-facing with the lens pointing away from the endoscope. Some physicians insert the capsule with the opposite orientation to confirm deployment by visualizing light source after release. This practice can result in damage to the lens when the metal core is fired, thereby affecting obtained images and decreasing study quality. In this series, each VCE showed a linear scratch on the lens. This scratch can be misinterpreted as a lesion, as well as interfere with the reading of the study. Summary: It is important to take into consideration orientation of the VCE with a forward-facing lens when loading into the endoscopic deployment device. This will prevent lens damage and ensure that the highest quality images possible are obtained during study, optimizing VCE efficacy. Physician awareness is needed to prevent this potential pitfall.Figure 1.: Proper orientation of the capsule device into the endoscopic deployment device.Figure 2.: Capsule images with evidence of lens damage, causing linear scratches on images.Figure 3.: Capsule images with evidence of lens damage, causing linear scratches on images.