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Vol. 83. Núm. 3.Julio - Septiembre 2018
Páginas 213-364
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Vol. 83. Núm. 3.Julio - Septiembre 2018
Páginas 213-364
Letter to the Editor
DOI: 10.1016/j.rgmxen.2017.08.010
Open Access
Video capsule retention in capsule endoscopy: How to prevent, diagnose, and manage that complication
A propósito de la retención de cápsula endoscópica: cómo prevenir, diagnosticar y manejar esta complicación
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D. García-Compeán
Autor para correspondencia
digarciacompean@prodigy.net.mx

Corresponding author. Servicio de Gastroenterología, Departamento de Medicina Interna, Hospital Universitario «Dr. José Eleuterio González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico, Madero y Gonzalitos s/n, Monterrey, Nuevo León, Mexico, C.P. 64460; Phone/fax: +52 (81) 83333664.
, E.I. González-Moreno
Servicio de Gastroenterología, Departamento de Medicina Interna, Hospital Universitario «Dr. José Eleuterio González», Universidad Autónoma de Nuevo León, Nuevo León, Mexico
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Dear Editors:
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We would like to comment on the article by Dr. Roesch-Dietlen et al.1 about a patient with Peutz-Jeghers syndrome, in which a video capsule (VC) was associated with bowel obstruction.

VC retention is the most dreaded event in capsule endoscopy. Overall prevalence is around 2%.2 There are risk factors associated with greater frequency: a) suspicion of bowel stricture, b) chronic NSAID use, c) suspicion of tumor, and d) Crohn's disease. In those cases, a prior imaging study is recommended to evaluate the permeability of the small bowel.3 Computed tomography with oral contrast (“enteric phase” CAT) has greater sensitivity and specificity than bowel transit with barium. However, there is no absolute certainty, given that stricture and capsule retention have been reported, even when imaging studies are normal. Thus, some authors recommend the reabsorbable Agile capsule, but it is not available in Mexico and its results are controversial.4

Furthermore, capsule retention is usually asymptomatic and impaction (the term used to describe the lodging of the capsule in the stricture that results in complete bowel obstruction, as was the case of the patient in the article under discussion) is rare, and dependent on the severity of the stricture. The site and nature of the lesion is generally revealed through the retention, enabling the planning of an elective approach. One third of patients are reported to undergo single-balloon or double-balloon enteroscopy or a surgical intervention to simultaneously recover the capsule and treat the cause of the stricture before symptoms develop. The rest of the patients receive medical treatment or expectant management. Of those patients, half end up having a surgical procedure and the other half spontaneously pass the VC.5

Based on the above, we recommend the following measures for reducing the possibility of retention:

  • 1.

    Before the procedure, look for risk factors of stricture and evaluate intestinal permeability through an imaging study.

  • 2.

    Upon completing the study, systematically verify capsule expulsion visually or through a plain abdominal x-ray as soon as there are abdominal symptoms, or in 7 days if there are no symptoms, especially in patients with an incomplete study of the small bowel, even when no stricture is detected.

  • 3.

    When there is retention with stricture, plan the medical, endoscopic, or surgical treatment, focusing first on the underlying disease, and then on the recovery of the VC. In those cases, abdominal symptoms are crucial for determining treatment urgency. In asymptomatic retention with stricture causing partial obstruction, medical treatment or expectant management can result in spontaneous late passage of the capsule, allowing other nonsurgical elective treatment alternatives to be explored.

Financial disclosure

No financial support was received in relation to this study/article.

Conflict of interest

The authors declare that there is no conflict of interest.

References
[1]
F.B. Roesch-Dietlen,A.D. Cano-Contreras,A. Meixueiro-Daza
Bowel obstruction due to capsule endoscopy in a patient with Peutz-Jeghers syndrome [Article in English, Spanish]
Rev Gastroenterol Mex, (2017),
[2]
M. Rezapour,C. Amadi,L.B. Gerson
Retention associated with video capsule endoscopy: Systematic review and meta-analysis
Gastrointest Endosc, 85 (2017), pp. 1157-1168 http://dx.doi.org/10.1016/j.gie.2016.12.024
e2
[3]
R.A. Enns,L. Hookey,D. Armstrong
Clinical Practice Guidelines for the Use of Video Capsule Endoscopy
Gastroenterology, 152 (2017), pp. 497-514 http://dx.doi.org/10.1053/j.gastro.2016.12.032
[4]
D. Cave,P. Legnani,R. de Franchis
ICCE consensus for capsule retention
Endoscopy, 37 (2005), pp. 1065-1067 http://dx.doi.org/10.1055/s-2005-870264
[5]
J.H. Cheon,Y.S. Kim,I.S. Lee
Can we predict spontaneous capsule passage after retention? A nationwide study to evaluate the incidence and clinical outcomes of capsule retention
Endoscopy, 39 (2007), pp. 1046-1052 http://dx.doi.org/10.1055/s-2007-966978

Please cite this article as: García-Compeán D, González-Moreno EI. A propósito de la retención de cápsula endoscópica: cómo prevenir, diagnosticar y manejar esta complicación. Revista de Gastroenterología de México. 2018;83:361–362.

Copyright © 2018. Asociación Mexicana de Gastroenterología
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