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Wireless Capsule Endoscopy Requiring Surgical Intervention

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Neha Kantawala and JS Rajkumar    23 December 2022

Neha Kantawala and JS Rajkumar

Chennai, Tamil Nadu

 

Abstract

 

Wireless capsule endoscopy is a relatively new diagnostic technique for the detection of small bowel disease. Currently, it represents an increasingly used method for diagnostic evaluation of the small intestine. It is important for surgeons to be familiar with its uses and complications that may arise. We report an interesting case of spontaneous video capsule entrapment in small bowel Crohn’s disease in which diagnosis was made radiologically.

 

Introduction

 

Wireless capsule endoscopy is a relatively new diagnostic technique for the detection of small bowel disease. This minimally invasive procedure generally poses few risks to the patients and reported complications typically are related to capsule retention. The retrospective analysis of some series indicates that the incidence of capsule retention depends on the indication for the capsule examination 0% in healthy controls, 1.4% in obscure gastrointestinal bleeding, 1.48% in suspected Crohn’s disease, 5-13% in known Crohn’s disease and 21% in suspected small bowel obstruction. We report an interesting case of spontaneous video capsule entrapment in small bowel Crohn’s disease in which diagnosis was made radiologically.

 

Case Report

 

A 35-year-old woman was evaluated for persistent fever and weight loss in a known case of Crohn’s disease. She had no gastrointestinal symptoms. CT scan of abdomen was normaland colonoscopy revealed terminal ileal Crohn’s disease. Small intestine evaluation was thus pursued and wireless capsule endoscopy was performed. Unfortunately, as the endoscopic images revealed, the capsule became lodged in small intestine segment containing stagnant contents and eventually lost battery power. As patient had no symptoms of obstruction, he was called for review after 15 days. An abdominal radiograph showed video capsule in the right lower quadrant. CT of the abdomen revealed that the video capsule was caught in the ileum. As patient had persistent weight loss and persistent fever with capsule retention, itwas planned to proceed with diagnostic laparoscopy, which revealed multiple strictures in terminal ileum with capsule retained in proximal stricture. There were five completestrictures in terminal ileum so we decided to proceed with resection with ileotransverse anastomosis. Postoperatively, the patient recovered well.

 

Discussion

 

Wireless capsule endoscopy was approved for clinical use in United States in 2001 and currently represents an increasingly used method for diagnostic evaluation of the small intestine. It is important for surgeons to be familiar with its uses and complication that may arise. In our case, CT scan of the abdomen was done to rule out strictures. The endoscopiccapsule examination begins when the patient swallows the 1.1 × 2.6 cm, 4 g capsule, which contains a camera, light source, batteries and transmitter. As the capsule transverses the small intestine, it relays images to a recorder worn on a belt around the patient’s waist. The capsule battery has a life span of about 8 hours, typically enough time for it to image the entire small bowel as it passes through. Recorded images are downloaded and analyzed later. Most capsules are naturally expelled within 72 hours of ingestion. Current imaging techniques can show long or medium stenosis, with great reduction of lumen size; however, short stenosis usually cannot be detected by standard methods. This fact explains that in most of the reported cases of capsule retention, the previous performance of the usual radiological studies was not capable of diagnosing the intestinal strictures which the capsule clearly showed. It is therefore, proven that the lack of findings in radiological techniques does not rule out theexistence of bowel stenosis. 

 

Suggested Reading

 

  1. Delaney CP, Fazio VW. Crohn’s disease of the small bowel. Surg Clin North Am 2001;81(1):137-58, ix.
  2. Iddan G, Meron G, Glukhovsky A, et al. Wireless capsule endoscopy. Nature 2000;405(6785):417.
  3. Gong F, Swain P, Mills T. Wireless endoscopy. Gastrointest Endosc 2000;51(6):725-9.
  4. Swain P. Wireless capsule endoscopy. Gut 2003;52 Suppl 4:iv48-50.
  5. Fritscher-Ravens A, Swain CP. The wireless capsule: new light in the darkness. Dig Dis 2002;20(2):127-33.
  6. Bar-Meir S, Bardan E. Wireless capsule endoscopy – pros and cons. Isr Med Assoc J 2002;4(9):726.
  7. Fireman Z, Glukhovsky A, Jacob H, et al. Wireless capsule endoscopy. Isr Med Assoc J 2002;4(9):717-9.
  8. Ge ZZ, Hu YB, Gao YJ, et al. Clinical application of wireless capsule endoscopy. Zhonghua Xiaohua Zazhi 2003;23:7-10.
  9. Ang TL, Fock KM, Ng TM, et al. Clinical utility, safety and tolerability of capsule endoscopy in urban Southeast Asian population. World J Gastroenterol 2003;9(10):2313-6.
  10. Appleyard M, Fireman Z, Glukhovsky A, et al. A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small-bowel lesions.Gastroenterology 2000;119(6):1431-8.
  11. Costamagna G, Shah SK, Riccioni ME, et al. A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Gastroenterology 2002;123(4):999-1005.
  12. Bardan E, Nadler M, Chowers Y, et al. Capsule endoscopy for the evaluation of patients with chronic abdominal pain. Endoscopy 2003;35(8):688-9.
  13. Schreyer AG, Gölder S, Seitz J, et al. New diagnostic avenues in inflammatory bowel diseases. Capsule endoscopy, magnetic resonance imaging and virtual enteroscopy. DigDis 2003;21(2):129-37.
  14. Tibble JA, Bjarnason I. Non-invasive investigation of inflammatory bowel disease. World J Gastroenterol 2001;7(4):460-5.
  15. Lewis BS. Radiology versus endoscopy of the small bowel. Gastrointest Endosc Clin N Am 1999;9(1):13-27.
  16. Chong AK. Comments regarding article comparing small bowel radiographs and video capsule endoscopy. Gastroenterology 2003;125(1):276.
  17. Liangpunsakul S, Chadalawada V, Rex DK, et al. Wireless capsule endoscopy detects small bowel ulcers in patients with normal results from state of the art enteroclysis. Am JGastroenterol 2003;98(6):1295-8.
  18. MacKenzie J. Push enteroscopy. Gastrointest Endosc Clin N Am 1999;9(1):29-36.
  19. Gay GJ, Delmotte JS. Enteroscopy in small intestinal inflammatory diseases. Gastrointest Endosc Clin N Am 1999;9(1):115-23.
  20. Seensalu R. The sonde exam. Gastrointest Endosc Clin N Am 1999;9(1):37-59.
  21. Delmotte JS, Gay GJ, Houcke PH, et al. Intraoperative endoscopy. Gastrointest Endosc Clin N Am 1999;9(1):61-9.
  22. Ge ZZ, Xiao SD. Prospects for wireless capsule endoscopy. Wei Chang Bing Xue 2002;7:326-30.
  23. Barkin J, Friedman S. Wireless capsule endoscopy (WCE) requiring surgical intervention: The world’s experience. 2nd Conference on Capsule Endoscopy, Berlin 2003:171.

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