Retention associated with video capsule endoscopy: systematic review and meta-analysis

  • Mona Rezapour
    Affiliations
    Division of Gastroenterology, California Pacific Medical Center, San Francisco, California, USA
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  • Chidi Amadi
    Affiliations
    Department of Medicine, King’s College, London, England
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  • Lauren B. Gerson
    Correspondence
    Reprint requests: Lauren B. Gerson, MD, MSc, Director of Clinical Research, Gastroenterology Fellowship Program, California Pacific Medical Center, Associate Clinical Professor of Medicine, University of California San Francisco, San Francisco, CA 94115.
    Affiliations
    Division of Gastroenterology, California Pacific Medical Center, San Francisco, California, USA

    Division of Medicine, University of California San Francisco, San Francisco, California, USA
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Published:January 06, 2017DOI:https://doi.org/10.1016/j.gie.2016.12.024

      Background and Aims

      Video capsule endoscopy (VCE) has become a major diagnostic tool for small-bowel evaluation. However, retention of the video capsule endoscope remains a major concern.

      Methods

      We performed a systematic review of VCE retention rates by using Pubmed and SCOPUS (1995-2015). We included studies that enrolled at least 10 patients, included VCE retention rates, and separated retention rates by indication. We used Comprehensive Meta-Analysis (Version 3.0) to calculate pooled prevalence rates with 95% confidence intervals (CIs) and assessed heterogeneity by using the Cochran Q statistic.

      Results

      We included 25 studies (N = 5876) for patients undergoing VCE for evaluation of potential small-bowel bleeding, 9 studies (N = 968) for patients with suspected inflammatory bowel disease (IBD), 11 studies (N = 558) for patients with established IBD, and 8 studies for patients (N = 111) undergoing VCE for evaluation of abdominal pain and/or diarrhea. We used a random effects model and found that the pooled retention rate was 2.1% for patients with suspected small-bowel bleeding (95% CI, 1.5%-2.8%). Retention rates were 3.6% (95% CI, 1.7%-8.6%) for suspected IBD, 8.2% (95% CI, 6.0%-11.0%) for established IBD, and 2.2% (95% CI, 0.9%-5.0%) for abdominal pain and/or diarrhea. Based on subgroup analysis, subsequent VCE completion rates after performance of a patency capsule or CT enterography in patients with IBD to exclude retentions due to strictures was 2.7% (95% CI, 1.1%-6.4%). Reasons for retention were provided in 60 (77%) studies. The most common reasons for retention were small-bowel strictures, although etiology was not provided in all studies.

      Conclusion

      VCE retention occurs in approximately 2% of patients undergoing evaluation for small-bowel bleeding and is most likely due to small-bowel strictures. Retention rates in patients with suspected or known IBD were approximately 4% and 8%, based on our meta-analysis. These rates decreased by half in those studies that used either a patency capsule or CT enterography to assess patency before performing VCE.

      Abbreviations:

      IBD (inflammatory bowel disease), MR (magnetic resonance), NSAID (nonsteroidal anti-inflammatory drug), VCE (video capsule endoscopy)
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      Linked Article

      • Retention rate in small-bowel capsule endoscopy
        Gastrointestinal EndoscopyVol. 86Issue 3
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          We read the recent article by Rezapour et al1 with great interest. The authors reported a video capsule endoscopy (VCE) retention rate of 3.6% in suspected inflammatory bowel disease (IBD) and 8.2% in established IBD. However, it appears that the study design precluded the inclusion of several recent publications, which may have shifted the pooled ratios for VCE retention downward. We note that Rezapour et al1 excluded from the main analysis studies in which the patency capsule or cross-sectional imaging was used.
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