Videocapsule retention: role of surgical treatment (a case report)

Retention of an endoscopic videocapsule on inflammatory polyposis of the small bowel

The Video Capsule Diagnostic Imaging is a technique for exploring the digestive tract, particularly the small bowel. It is indicated for any unexplained digestive bleeding or as a means of monitoring intestinal polyposis or inflammatory diseases. This videocapsule is not digestible, and the risk of its retention, symptomatic or not, is not negligible following an inflammatory, anastomatous or tumoral stenosis. This retention or blockage is defined by the presence of the Video Capsule in the digestive tract at least two weeks after ingestion. Surgical approach is considered effective to retrieve the retained capsule, treat the pathology responsible and prevent acute complications.

We report the case of retention of a video capsule in a young patient with severe anaemia due to inflammatory polyposis of the small bowl, whose removal required surgery to extract the capsule and resect the segment of the small intestine stenosis by the polyps.

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The video Capsule Endoscopy is the most sensitive examination for the detection of inflammatory lesions of the small bowel.

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It does not currently allow a biopsy but it is indicated for unexplained or occult digestive bleeding.

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Its main limitation is the risk of blockage in a stenosis with or without occlusion.

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Surgical approach is considered effective to retrieve the retained capsule, and treat the pathology responsible.

Clinical factors related to false-positive rates of patency capsule examination

BACKGROUND

Retention is the most common complication of capsule endoscopy (CE), and is reported to occur in 0-13% of cases. To avoid retention, a PillCam patency capsule (PC) is used in patients with suspected intestinal stenosis. However, a relatively low positive predictive value of the PC examination has been reported previously. The aims of this study were to clarify the accuracy of PC examination and to evaluate clinical factors related to cases of false-positive detection.

METHODS

We performed a retrospective single-center study of 282 consecutive patients referred for PC examination. Patients in which the PC could not pass through the small bowel within 33 h were classified into the 'no patency' group. The 'no patency' group was investigated for evidence of significant stenosis upon further examinations, including CE, double-balloon endoscopy, and small bowel follow-through after PC examination. Clinical factors related to small bowel patency and false-positive cases were evaluated.

RESULTS

We included 161 male (57.1%) and 121 female (42.9%) patients with a mean age of 47.5 ± 17.7 years. Of the 282 patients enrolled, 27 patients exhibited 'no patency' upon PC examination. Multivariate analysis showed that clinical factors related to 'no patency' included Crohn's disease, abdominal symptoms, stenosis upon imaging, and previous abdominal surgery. Upon further examination, nine cases in the 'no patency' group had significant stenosis. Sensitivity, specificity, and negative and positive predictive values of PC examination for detecting small bowel stenosis were 93.8%, 96.6%, 99.6%, and 62.5%, respectively, and the only clinical factor related to false-positive cases was constipation (p < 0.05).

CONCLUSION

We found a relatively low positive predictive value of PC examination and that constipation was related to false-positive results. To extend the implications of CE indications, clinical study focusing on these results is expected.