Learning objectives
1. Capsule endoscopy- indications and use.
2. Assessment pre-capsule endoscopy-small bowel investigation and patency capsules.
3. Examples of cases of retained capsules on plain film, CT and MRI.
4. Complications of retained capsules and identification of high-risk patients.
Background
Video capsule endoscopy (VCE) is an excellent, minimally invasive diagnostic tool. It is remarkably well-tolerated and enables visualisation of otherwise unreachable sections of bowel (1). It has multiple diagnostic utilities including: diagnosing and monitoring Crohn’s and Coeliac disease, assessing obscure gastrointestinal bleeding and identifying small bowel tumors, amongst others Fig. 2 .
Imaging the small bowel
Prior to the development of VCE in 2000, existing methods to visualise the small bowel were limited and invasive. VCE has enabled the entirety of the small bowel mucosa...
Findings and procedure details
Imaging the bowel prior to VCE
Prior to the advent of the patency capsule in 2005, investigating small bowel patency was not routine practice for patients undergoing VCE. Thus, it not surprising that there are a number of asymptomatic patients with incidentally detected retained VCE capsules Fig. 8 .
Various imaging modalities are employed in evaluating small bowel patency:
A)Small bowel follow-through
B)CT enterography
C)MR enterography and enteroclysis
A)Small bowel follow-through (SBFT)
√ SBFT can demonstrate strictures including approximate length and position
Fig. 9
×...
Conclusion
VCE is an important tool in investigating the small bowel for various suspected pathologies. Its diagnostic abilities are unquestionable but complications may arise secondary to small bowel strictures and optimal pre/ post procedure imaging is warranted to minimise these risks.
The gold standard for assessing functional patency remains the patency capsule which can be used in conjunction with low dose CT abdomen/pelvis to visualise retained capsules. We have used a series of illustrative case examples to highlight why abdominal radiographs should not be used, due...
Personal information and conflict of interest
V. Naidu; Royal Free Hospital NHS Trust/UK-nothing to disclose; S. Zafar, Royal Free Hospital NHS Trust/UK-nothing to discloseG. Kakar; Royal Free Hospital NHS Trust/UK-nothing to disclose O. Y. Wong; Royal Free Hospital NHS Trust/UK-nothing to disclose H. Steinitz; Royal Free Hospital NHS Trust/UK-nothing to disclose K. Planche; Royal Free Hospital NHS Trust/UK-nothing to disclose.
References
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2.Iddan G,Meron G,Glukhovsky A,Swain P. Wireless capsule endoscopy. Nature. 2000;405(6785):417.
3.Caunedo-Alvarez A,Romero-Vazquez J,Herrerias-Gutierrez JM. Patency and Agile capsules. World J Gastroenterol. 2008;14(34):5269-73.
4.Cave D,Legnani P,de Franchis R,Lewis BS. ICCE consensus for capsule retention. Endoscopy. 2005;37(10):1065-7.
5.Pasha SF,Pennazio M, Rondonotti E,Wolf D,Buras MR,Albert JG,et al. Capsule Retention in Crohn's Disease: A Meta-analysis. Inflamm Bowel Dis. 2020;26(1):33-42.
6.Cheifetz AS,Kornbluth AA,Legnani P,Schmelkin I,Brown A,Lichtiger S, et al. The risk...