Double-balloon endoscopy as the primary method for small-bowel video capsule endoscope retrievalDisclosure

Background

Capsule retention in the small bowel is a known complication of small-bowel video capsule endoscopy. Surgery is the most frequently used method of capsule retrieval.

Objective

To determine the incidence and causes of capsule retention and to describe double-balloon endoscopy (DBE) as the primary technique used for capsule retrieval.

Design

Retrospective analysis of all video capsule studies was performed at our center, and evaluation of the outcome of DBE was the first method used to retrieve entrapped video capsules.

Setting

Tertiary referral center.

Patients

A total of 904 patients who underwent small-bowel video capsule endoscopy.

Interventions

Capsule retrieval by DBE.

Main Outcome Measurements

The number of patients in whom capsule retention occurred and the number of patients in whom an entrapped capsule could be retrieved by using DBE.

Results

Capsule retention occurred in 8 patients (incidence 0.88%; 95% CI, 0.41%-1.80%) and caused acute small-bowel obstruction in 6 patients. All retained capsules were successfully removed during DBE. Five patients underwent elective surgery to treat the underlying cause of capsule retention. One patient required emergency surgery because of multiple small-bowel perforations.

Limitations

Retrospective design.

Conclusions

In our series, the incidence of capsule retention was low. DBE is a reliable method for removing retained capsules and might prevent unnecessary surgery. If surgery is required, preoperative capsule retrieval allows preoperative diagnosis, adequate staging in case of malignancy, and optimal surgical planning.

Abbreviations: DBE, double-balloon endoscopy, NSAID, nonsteroidal anti-inflammatory drug, VCE, video capsule endoscopy