Retained Wireless Capsule Endoscope in a Girl with suspected Crohn’s Disease
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Abstract:
Wireless capsule endoscopy (WCE) is one of the great milestones in the field of gastroenterology. It is versatile in image acquisition, painless and can reach parts of the small bowel not amenable to conventional endoscopy. The commonest complication with WCE is retention of the capsule. We report a case of retained capsule in a child who was being investigated for obscure gastrointestinal bleeding (OGIB). Operative intervention was required for its retrieval after two weeks of expectant management.Keywords:
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Endoscope
Girl
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Capsule endoscopy has become an important tool in the diagnosis of small-bowel diseases [1] [2]. The M2A capsule is 11 × 27 mm in size, and for most patients, swallowing the capsule does not pose any problems. However, some patients may have difficulties, and different methods of overcoming these have been described [3] [4]. We describe the ingestion of an M2A capsule through an overtube.
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Aims Capsule retention is a serious complication of capsule endoscopy. Retention rates range from 1% to 4.8%. The introduction of patency capsules has had a major role improving this. The aim was to analyse usage of patency test in our institute against guidelines.
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Capsule endoscopy is an effective tool for evaluating small bowel diseases. Capsule retention is a complication of capsule endoscopy, but capsule disruption after retention has not been thoroughly studied. Only a few cases of capsule disruption have been reported. We report a case of capsule disruption after prolonged retention. A 73-year-old woman underwent capsule endoscopy for the evaluation of anemia. One week later, capsule retention was observed on radiography. Capsule removal was advised, but she refused because she did not have any symptoms. After 20 months, computed tomography revealed disrupted capsule fragments. Capsule removal was strongly recommended, and the patient agreed. All disrupted capsule fragments were removed using double-balloon endoscopy without complications. Intestinal perforation had been prevented by removing the disrupted capsule before the battery fluid leaked into the intestinal tract. Capsule retention, documented by imaging, should be addressed by removing the retained capsule immediately before capsule disruption occurs.
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Capsule retention is one of the major complications of capsule endoscopy, which range from 2.1 to 8.2% depending on the indication. Over the last few years, reported rates of retention have fallen due to better patient selection due to the recognition of risk factors for capsule retention as well as the introduction of the patency capsule. The patency capsule is a dissolvable capsule with the same dimensions as the functional capsule. It breaks down in the GI tract after approximately 30 h, reducing the risk of symptomatic retention. Failure to pass this patency capsule out of the small bowel results in the patient being excluded from capsule endoscopy. We performed a retrospective analysis of the patency capsules performed in our unit over a 12-month period. A total of 166 (14.7%) of 1,127 patients referred for capsule endoscopy were deemed to require patency assessment (45.8% men, mean age 48 years). Of those who passed the patency assessment and underwent capsule endoscopy, no capsule retention was seen. Indication for patency assessment was found to be appropriate in 87.0% (n = 147). Overall, the failure rate at the patency assessment was 43.1%. The patency capsule remains an imperfect but useful tool in examining functional patency of the GI tract prior to capsule endoscopy.
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This study compares the differences in the gastrointestinal transit time between the conventional capsule endoscope and a minimized capsule endoscope model in normal dogs to verify whether the minimization of capsule endoscope can help relief retention in the gastrointestinal tract, especially in the pyloric passage. Three male beagles were used as the experimental group for which the minimized capsule endoscope model was orally administered and the control group consisted of three beagle dogs for which the conventional capsule endoscope was orally administered. Nine experiments were conducted with three experiments for each dog in each group. The results showed a significant difference in the gastric transit time (GTT) by the minimization of the capsule endoscope between the two groups (control group: 123.3 ± 80 min, experimental group: 63.3 ± 40.9 min, p=0.019). In contrast, the difference in the small bowel transit time (SBTT) by the minimization of the capsule endoscope between the two groups (control group: 86.6 ± 58.9 min, experimental group: 80 ± 33.5 min, p=0.863) was not significant. In this study, the capsule endoscopes reached the large intestine without retention in the small intestine in all subjects. The significant difference in the GTT between the control group using the conventional capsule endoscope and the experimental group using the minimized capsule endoscope model suggests that the smaller size of the capsule endoscope is helpful in resolving retention in the gastrointestinal tract, thus shorting the GTT.
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Objective
To evaluate the risk factors, treatment and follow–up of capsule retentions after capsule endoscopy examination.
Methods
A total of 1 100 capsule enteroscopic examinations, performed at our hospital from October 2006 to March 2013, were retrospectively studied. The positive findings of lesions, clinical indications of capsule endoscopy, treatment and follow–ups were recorded.
Results
The incidence of capsule retentions was 1.18%(n=13). The rates of capsule retentions in OGIB, suspected Crohn's disease(CD), known CD, suspected tumors and chronic abdominal pain were 0.95%, 4.0%, 10.5%, 7.1% and 0.3%, respectively. In 11 patients, the capsule was removed by means of double–balloon enteroscopy, the capsule was removed surgically in one patient, and spontaneous expulsion occurred in another patient after 1 year of treatment. Risk factors for capsule retention were known or suspected CD and suspected tumor(OR=11.44, P=0.02; OR=5.59, P=0.02), and suspected tumor was also a risk factor(OR=7.42, P=0.04).
Conclusion
Capsule endoscopy is a safe procedure with low risk of capsule retentions. Advantages and disadvantages of capsule endoscopy examinations should be considered carefully when high–risk patients are involved.
Key words:
Capsule endoscopes; Retention; Risk factors
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