Capsule retention: prevention, diagnosis and management

Abstract

Capsule retention (CR) has been defined as capsule remaining in the digestive tract for a minimum of two weeks. CR occurs approximately in 2% of all patients undergoing small bowel capsule endoscopy (CE). Prompt diagnosis of CR is important, as it has relevant clinical implications. CR should be suspected in (I) all asymptomatic patients who do not report capsule excretion within 15 days from capsule ingestion; and (II) patients with obstructive or perforation-related symptoms in which the capsule has not been excreted, regardless of the time between the onset of symptoms and capsule ingestion. Abdominal plain X-ray is the preferred test to confirm CR. An abdominal CT scan should be performed, on individual basis, if knowledge of the precise location of the retained capsule is necessary or whenever clinically indicated. Since CR is usually asymptomatic, an initial watchful monitoring is suggested. In inflammatory bowel disease (IBD) patients, a short course of medical therapy may allow capsule excretion. Nevertheless, in long-term CR, some cases of capsule fragmentation, acute obstruction and perforation have been described. Therefore, retrieval of the retained capsule is recommended if asymptomatic CR lasts for long time. A safe capsule retrieval is usually performed by endoscopy, whereas surgery remains a viable alternative if the first is unsuccessful or when clinically indicated. Either Patency Capsule (PC) or dedicated small bowel cross-sectional imaging techniques have been proposed to prevent CR. Both have pros and cons, but head-to-head comparative studies are lacking.

Colon Capsule Endoscopy vs. CT Colonography Following Incomplete Colonoscopy: A Systematic Review with Meta-Analysis

“…The incompletion of colonoscopy is often ascribed to nonpassable segments, stenosis or other obstacles of passage, which are thought to potentially increase the risk of capsule retention, since the highest rate of capsule retention in small bowel capsule endoscopies has been due to obstructions [ 13 ]. Research from our unit has shown that the completion rates of CCE after IC (68%) and CCE in patients in a surveillance program (67%) are comparable.…”

Motorized spiral enteroscope-assisted retrieval of video capsule in a patient with Crohn’s disease

“…[1][2][3] In the majority of cases, capsule retention is asymptomatic, but capsule retrieval should be attempted in the event of symptoms or in patients with prolonged retention (especially in the presence of strictures) because of the risk of perforation or disintegration of the capsule. [2][3][4] Novel MSE incorporates a motor in the handle of the enteroscope and a disposable short spiral overtube mounted on the insertion end, which has distinct advantages. Motorization ensures smooth and safe insertion and withdrawal of the enteroscope.…”

Endoscopy in inflammatory bowel disease: from guidelines to real life

“…Capsule retention remains the most relevant procedure-related complication, with the risk of capsule retention increasing from 1% to 2% (non-IBD patients) up to over 10% in confirmed IBD patients. 29…”