Limitations of capsule endoscopy – A single center study on 1193 consecutive examinations

Introduction/Objectives: Over the past years, capsule endoscopy (CE) has been established as an imaging technique in the diagnosis of small bowel diseases. The aim of this study was to examine the limitations of this method by analysing a large number of consecutive CEs.

Patients and Methods: This was a retrospective study, including 1193 consecutive examinations performed at our centre in 1091 patients (male/female = 517/574, mean age ± SD: 61.83 ± 17.46a, range: 9 – 93a) between 2002 and 2012. In 1061 examinations the system of Given® (Yoqneam, Israel) was used. In 132 examinations the capsule endoscope MiroCam® (IntroMedic, Seoul, South Korea) was used.

Results: Complications requiring an endoscopic or surgical intervention occurred in 0.34% (4/1193) of examinations: In two patients the capsule was retained in a duodenal diverticulum or a hiatal hernia, respectively. In both cases the capsule could be removed endoscopically. In one patient with Crohn's disease (CD) the capsule was retained in a stenosis of the terminal ileum and was removed during colonoscopy after dilation of the stricture. One patient underwent surgery after the capsule was retained in a stenosis caused by CD.

Technical defects of the capsule or the data recorder occurred in 16 (1.34%) CEs: Hence the passage through the small intestine was not completely recorded (n = 12) or the pictures could not be used for further evaluation (n = 4).

Transit abnormalities: In 1017 examinations (85.25%) the cecum was reached within the recording period.

Visibility conditions were classified as very good 54.41%, as partly limited in 32.05% and as severely limited during the most part of recording in 13.54% of examinations.

Conclusion: Complications of CE requiring endoscopic or surgical intervention are very rare (0.34%). However, technical defects as well as transit abnormalities and limited visibility may decrease the diagnostic yield of CE in some cases.