Adverse events of video capsule endoscopy over the past two decades: a systematic review and proportion meta-analysis

Abstract

Background: A full spectrum of video capsule endoscopy (VCE) adverse events over the past two decades has not been evaluated. We aimed to determine pooled rates, predictors and temporal-trend of VCE adverse events over the past two decades. Methods: Systematic search of PubMed and EMBASE for English-language publications reporting VCE adverse events (January 1, 2000 to March 31, 2019). Data were extracted independently by two investigators. Pooled VCE adverse event rates were calculated using the random or fixed model as appropriate. Predictors and temporal-trend of each adverse event were performed by meta-regression analyses. Results: In total, 402 studies were identified, including 108,079 VCE procedures. Rate of retention, swallow disorder, aspiration, technical failure, and procedural adverse events were 0.73% (95% confidence interval [CI], 0.59%-0.89%), 0.75% (95% CI, 0.43%-1.13%), 0.00% (95% CI, 0.00%-0.00%), 0.94% (95% CI, 0.65%-1.28%), 0.67% (95% CI, 0.32%-1.10%), respectively; incomplete examination rate of esophagus, stomach, small bowel, and colon were 9.05%, 7.69%, 12.08%, 19.19%, respectively. Patency capsule reduced retention rate by 5.04%, whereas known inflammatory bowel disease increased retention rate by 4.29%. Elder was the risk and protective factor for small bowel incomplete examination (0.30%) and swallow disorder (-0.72%), respectively. Rates of retention and small bowel incomplete examination significantly declined over time (P = .0006 and P < .0001).Conclusions: VCE adverse event rates were generally low, and retention and small bowel incomplete examination rates declined over the past two decades. Patients with known inflammatory bowel disease or elder should be alerted to high risk of retention or small bowel incomplete examination (PROSPERO: CRD42019139595).

Scoring Systems for Clinical Colon Capsule Endoscopy—All You Need to Know

“…In a recent meta-analysis, the pooled adverse event rate for capsule retention was 0.26% (95% CI 0.00–0.77), whilst the procedural discomfort rate was 0.81% (95% CI 0.15–1.80). The authors also demonstrated that the CCE technical failure rate was 1.76% (95% CI 0.76–3.06) [ 47 ]. This was defined as equipment malfunction, recording gaps, short battery life duration, activation failure and inability to download images.…”

“…Colonic incomplete examination, defined as CCE not excreted or not reaching the rectum within the recording time, was 19.19% (95% CI 14.06–25.88) [ 47 ].…”

Indications and Limitations Associated with the Patency Capsule Prior to Capsule Endoscopy

“…Clinicians will have to consider the adverse events associated with PC, such as the impaction of the PC at the stenotic site or intestinal perforation within 33 hours. The SBCE retention rate is reported to be approximately 1% (74,79). If a hospital's retention rate is higher than 1%, the indications and contraindications of PC may need to be reconsidered.…”

Artificial intelligence for the detection of polyps or cancer with colon capsule endoscopy

“…13 A limiting factor for this, however, is its availability and reliance on bowel preparation for complete and accurate imaging, when compared with longer-standing technologies, despite it being safe, more comfortable and acceptable to patients. 14,15 At present, reading a CCE recording is time-consuming and requires skilled and experienced readers. 16 Devices such as the PillCam COLON2 system from Medtronic record at a variable rate between 4 and 35 frames per second (fps) for a minimum of up to 10 hours, 17 thus providing hundreds of thousands of frames for review.…”