Z Gastroenterol 2011; 49 - P26
DOI: 10.1055/s-0031-1279863

Endoscopic duodenal placement of the capsule endoscope in patients with previous gastric retention of the capsule

E Dulic-Lakovic 1, B Blaha 1, A Halmetschleger 1, M Dulic 1, G Dworschak 1, M Gschwantler 1
  • 14th Department of Internal Medicine, Wilhelminenspital, Vienna, Austria.

Background: Incomplete visualization of the small bowel including gastric retention is a key limitation of wireless capsule endoscopy (CE). Several strategies how to improve small bowel completion rates of CE have been reported. The aim of this study was to determine the rate of gastric retention of the capsule in a large number of consecutive patients and to evaluate whether visualization of the entire small bowel could be achieved by endoscopic duodenal placement of the capsule in these patients.

Methods: This was a single-center, retrospective study. A total of 1.006 consecutive CE performed in 929 patients were reviewed. All patients with gastric retention of the capsule were included in this study. In the examinations the systems Given Imaging® (Yoqneam, Israel, n=943) and MiroCam® (n=63) were used. In all patients gastric outlet obstruction was excluded prior to CE. Gastric retention was defined as visualization of the capsule remaining in the stomach during the entire recording period. Small bowel examination was considered complete if the cecum was reached within the recording period.

Results: Gastric capsule retention occurred in 20 of 1.006 patients (2.0%, 8 women, 12 men, mean age±SD=67.3±10.8 years, range 43–82). In these 20 patients CE was performed during hospitalization in 18 patients (90%) and during an outpatient visit in 2 patients (10%).

Indications for CE in the 20 patients with gastric retention were: obscure-occult gastrointestinal bleeding (GIB) (n=5; 25%), obscure-overt GIB (n=8; 40%), non-specified obscure GIB (n=1; 5%), anemia without GIB (n=4; 20%), abdominal pain (n=1; 5%) and suspected celiac disease (n=1; 5%).

In 10 patients (5 women, 5 men, mean age±SD=68.2±11.0 years, range 43–82) CE was repeated with endoscopic duodenal placement of the capsule. In all 10 patients a complete small bowel examination was achieved (mean small bowel transit time±SD=268.2±117.1 minutes) and in 6/10 patients a clinically relevant lesion was found during the second CE.

Discussion: Gastric retention of the capsule is rare (2.0% of all examinations). Our data indicate that repeat CE with endoscopic duodenal placement of the capsule represents an approach with a high success rate in terms of achieving complete small bowel visualization in patients with previous gastric retention of the capsule.