Estudio de intestino delgado: experiencia en el uso de Cápsula Patency en la prevención de retención de Video-cápsula Endoscópica / Small bowel study: experience using Patency Capsule for prevention of video capsule endoscopy retention

Introduction: Video capsule endoscopy (VCE) is a useful test for the evaluation of the small bowel mucosa. The main complication of VCE is retention, so in patients with risk factors it is recommended to evaluate the permeability of the digestive tract with Patency Capsule (PC). We describe patients evaluated with PC before the study with VCE. Methods: Descriptive observational study of 96 patients referred for VCE. A clinical survey and images identified that 7 of these patients (7.3%) had retention risk factors, so they were previously requested PC. Results: 2 of the 7 patients evaluated with PC did not excrete the device, so the use of VCE was contraindicated; the subsequent study concluded Crohn's disease (CD) and jejunal stenosis due to retractable mesenteritis in these cases. Of the remaining 89 patients, not evaluated with PC, 1 (1.1%) developed retention of the VCE at an ulcerated stenosis, and was subsequently diagnosed as CD. Conclusion: In our study, we confirmed the usefulness of PC as a method to assess the risk of retention of VCE in patients with risk factors for ID stenosis.

Introducción: La video-cápsula endoscópica (VCE) es un examen útil para el estudio de patologías del intestino delgado (ID). La principal complicación de la VCE es la retención, por lo que en pacientes con factores de riesgo se recomienda evaluar la permeabilidad del tubo digestivo con Cápsula Patency (CP). Se presenta una serie de casos evaluados con CP previo al estudio con VCE. Métodos: Estudio observacional descriptivo de 96 pacientes derivados para realización de VCE. Mediante encuesta clínica e imágenes se identificó que 7 de estos pacientes (7,3%) tenían factores de riesgo de retención, por lo que se les solicitó previamente CP. Resultados: 2 de los 7 pacientes evaluados con CP no expulsaron el dispositivo por lo que se contraindicó el uso de VCE; el estudio posterior concluyó Enfermedad de Crohn (EC) y estenosis yeyunal por mesenteritis retráctil en estos dos casos. De los 89 pacientes restantes, no evaluados con CP, 1 (1,1%) presentó retención de la VCE a nivel de una estenosis ulcerada diagnosticada posteriormente como EC. Conclusión: En nuestra casuística se confirma la utilidad de la CP como un método para evaluar el riesgo de retención de VCE en pacientes con factores de riesgo de estenosis de ID.

Retención de cápsula endoscópica en un paciente con sospecha de enfermedad de Crohn / Endoscopic capsule retention in a patient with clinical suspicion of Crohn's disease

The endoscopic capsule is classically used in the study of occult bleeding, but has recently been shown to be useful in the diagnosis and follow-up of Crohn's disease. The retention of the capsule is the most frequent complication related to its use. We report the case of a 30-year-old male patient with recurrent abdominal pain and suspected Crohn's disease. A procedure with a video endoscopic capsule was performed; twelve hours after its ingestion, the patient goes to the emergency department due to worsening of the pain. Abdominal and pelvic CT demonstrates multiple areas of segmental parietal thickening of the ileum and a metallic foreign body in an area of stenosis corresponding to the retained endoscopic capsule. It evolves with persistent pain despite pharmacological therapy. Subsequently it is extracted by enteroscopy. The indications and risks of the use of the endoscopic video capsule, and the clinical and imaging factors predictive of retention are discussed.

La video cápsula endoscópica se utiliza clásicamente en el estudio de sangrado oculto, pero últimamente se ha demostrado su utilidad en el diagnóstico y seguimiento de la enfermedad de Crohn. La retención de la cápsula es la complicación más frecuente relacionada a su uso. Se presenta el caso de un paciente de sexo masculino de 30 años con dolor abdominal recurrente y sospecha de enfermedad de Crohn. Dentro del estudio se le realiza una video cápsula endoscópica; doce horas posteriores a su ingesta consulta en el servicio de urgencia por empeoramiento del dolor. La tomografía computada de abdomen y pelvis demuestra múltiples áreas de engrosamiento parietal segmentarias del íleon y un cuerpo extraño metálico en un área de estenosis, correspondiente a la cápsula endoscópica retenida. Evoluciona con persistencia del dolor pese a la terapia farmacológica. Posteriormente se procede a su extracción mediante enteroscopia. Se discuten las indicaciones y riesgos del uso de la video cápsula endoscópica, y los factores clínicos e imagenológicos predictores de retención.

Capsule retention caused by duodenal metastases from primary appendiceal adenocarcinoma

Metastatic small bowel cancers are extremely rare in clinical practice. Primary appendiceal adenocarcinoma with gastrointestinal metastasis is seldom reported in the literature. Here, we describe the case of an 80-year-old male patient with primary appendiceal adenocarcinoma, who presented to China Medical University Hospital with mid-gastrointestinal tract bleeding. Capsule endoscopy revealed stenotic bowel lumen, but the capsule was retained in the distal duodenum. Double-balloon enteroscopy demonstrated erosive and erythematous mucosa in the region of capsule retention. The retained capsule was retrieved successfully by using an electrosurgical snare. Histological examination and immunohistochemical staining of the biopsy specimen from the duodenal lesion strongly supported the diagnosis of metastatic appendiceal adenocarcinoma.

Small Bowel Obstruction and Capsule Retention by a Small Bowel Ulcer That Was Not Found on Capsule Endoscopy / 대한소화기내시경학회지

Capsule endoscopy (CE) is a valuable modality for directly examining the small bowel in a relatively noninvasive and safe manner. CE is being increasingly used for obscure gastrointestinal bleeding, Crohn's disease, drug induced ulcer and small bowel tumor. Although capsule retention is a relatively infrequent complication, small bowel obstruction and strictures have been considered contraindications to CE. But some authors have reported that capsule endoscopy can be safely used to help identify the etiology and site of small bowel obstruction, and the retention of the capsule indicates the presence of a lesion requiring surgery. We report here on a case of small bowel obstruction and capsule retention by a small bowel ulcer, and the small bowel ulcer was not found when performing capsule endoscopy.

A Case of Capsule Retention for 31 Days Due to Stricture of Crohn's Disease / 대한소화기내시경학회지

Conventional modalities for examination of the small bowel have significant limitations. Capsule endoscopy can allow visualization of areas of the small bowel, and is used to diagnose the etiology of gastrointestinal bleeding, small bowel involvement of Crohn's disease, small bowel tumors, polyposis syndromes as well as drug induced ulcers. The problems associated with capsule endoscopy are capsule retention after ingestion and inability to visualize an entire small bowel due to limitation of battery capacity and inadequate image generation. There are no guidelines for procedures to remedy capsule retention. We report a case of natural passage of a capsule after 31 days in a patient with small bowel ulcer due Crohn's disease using medical treatment.