Tu1216 Retained Capsule Endoscopy in a Large Tertiary Care Academic Practice

Abstract

Background/Aims: Capsule retention is a recognized complication of capsule endoscopy (CE) with reported rates between 1% and 13%. The objectives of this study were to determine the incidence, risk factors associated with, and clinical outcomes of capsule retention, and to define any cross-sectional imaging findings predictive of capsule retention. Methods: A retrospective review of all CE exams performed at our center from January 2002 to January 2013 was undertaken. Data on patient demographics, clinical history, CE indication and findings, and details of patient management, including capsule retrieval procedure, were abstracted from the medical records and analyzed. Radiologic images performed 6 months prior to CE were reviewed by experienced gastrointestinal radiologists. A control cohort of patients who had high risk features for capsule retention on cross-sectional imaging and passed the capsule was analyzed and compared to cases of CE retention. Results: A total of 5593 CEs were performed in the study period. Seventeen CE retentions (0.3%) occurred in 15 patients. The control cohort had 13 patients who passed the capsule, but had imaging features concerning for potential CE retention. Nine patients with CE retention were female (60%), with a median age of 54 years (range 37-80 years), and 5 patients had Crohn's disease (33%). Obscure gastrointestinal bleeding (OGIB) (47%) was the most common indication in the CE retention group (Table 1). Outcomes of retained capsule included: passing of capsule after treatment of intestinal inflammation (n=3), surgical intervention (n= 9), endoscopic retrieval (n=2), spontaneous passage after conservative measures for small bowel obstruction (SBO) (n=1), unsuccessful endoscopic retrieval followed by surgery (n= 1) and loss to follow-up (n=1). Culprit lesions included small bowel inflammation (n=5), anastomotic strictures (n=4), and small bowel adenocarcinoma (n=1). A total of 10 patients with CE retention had cross-sectional imaging within 6 months. On retrospective review, patients with CE retention were more likely to have small bowel (SB) anastomoses (88% vs. 23%) than patients with high-risk features for capsule retention who passed the capsule (Table 2). Conclusion: In a diverse tertiary care population, capsule retention occurred in 0.3% of cases. This rate is low compared to previous cohorts, attesting to careful patient selection. Patients with CE retention were more likely to have SB anastomoses and strictures compared to patients who passed the capsule. Table 1: Baseline characteristics of patients with retained capsules and a control group with radiographic features worrisome for increased risk of capsule retention but who passed a capsule