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

Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands.
Gastrointestinal endoscopy (Impact Factor: 5.37). 03/2010; 71(3):535-41. DOI: 10.1016/j.gie.2009.10.029
Source: PubMed


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.
To determine the incidence and causes of capsule retention and to describe double-balloon endoscopy (DBE) as the primary technique used for capsule retrieval.
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.
Tertiary referral center.
A total of 904 patients who underwent small-bowel video capsule endoscopy.
Capsule retrieval by DBE.
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.
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.
Retrospective design.
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.

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    • "Although there were many reports of capsule retention of long duration [4, 12, 13], we think that the retained CE should be retrieved if spontaneous or pharmaceutical manipulation, the rates of spontaneous or pharmaceutical-manipulated passage of retained capsules have been reported to vary from 15 to 65.6% [3, 14], is ineffective to egest it because there are several reports of retained capsule causing intestinal obstruction and perforation [5, 6, 8, 9]. Surgical retrieval is often required secondary to an underlying pathologic process causing a stricture or obstruction although double-balloon endoscopy has been reported as one of the effective approaches for the retrieval of retained CE [15, 16]. We removed the retained CE by laparoscopy-assisted surgery. "
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    ABSTRACT: A 50-year-old man with anemia was referred to our hospital to undergo capsule endoscopy (CE), which revealed small intestinal ulcers. After 5 months of CE, he returned because of recurrent anemia without abdominal symptoms. Abdominal X-ray and computed tomography showed capsule retention in the small intestine at the pelvic cavity. The capsule remained at the same place for 7 days. We performed capsule retrieval by laparoscopy-assisted surgery with resection of the involved small intestine, including an ileal stricture. Resected specimen showed double ulcers with different morphologies, an ulcer scar with stricture, and a wide ulcer at the proximal side of the others. Each ulcer had different histopathological findings such as the degree of fibrosis and monocyte infiltration. These differences led us to consider that the proximal ulcer may have been secondarily induced by capsule retention. Our experience indicated that careful follow-up and the cooperation between medical institutions after CE examination should be undertaken for patients with incomplete examination, unknown excretion of the capsule, and/or ulcerative lesions despite the lack of abdominal symptoms. Additionally, a retained CE remaining over long periods and at the same place in the small intestine may lead to secondary ulceration.
    09/2014; 2014:909360. DOI:10.1155/2014/909360
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    • "Several case reports have shown that a balloon-assisted endoscope can reach the deep small bowel and can be utilized to retrieve the retained capsule in patients not requiring emergency intervention.9,18-21 However, the retained capsule cannot always be removed using BAE. "
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    • "Other diagnostic tools which might be helpful in the diagnostic work-up of RCD patients include videocapsule enteroscopy (VCE), MR enteroclysis, and double balloon enteroscopy (DBE) which all allow visualization of intestinal lesions. VCE is useful in determining the extent of lesions and is less invasive than other endoscopic techniques [16, 25]. Comparison of VCE with MR enteroclysis indicates that both modalities are complementary in diagnostic accuracy in the analysis of small-bowel disease [26]. "
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