Journal of Crohn's and Colitis (2013) 7, e271–e272
Available online at www.sciencedirect.com
LETTER TO THE EDITOR Retained capsule extraction 6 years after wireless bowel capsule endoscopy: The importance of follow up
Dear Sir
A 34 year old female with a 15 year history of ileal non-fistulizing Crohn's disease (CD) reported mild abdominal tenderness. Physical examination revealed a distended abdomen and a mildly tender right lower quadrant. She previously received steroids, 5-ASA, steroid suppositories, immunomodulators, and biological agents over the course of her disease. Her colonoscopy revealed a stenotic ileocecal valve. An abdominal X-ray suggested a retained capsule. The patient was unaware she had not passed the capsule after wireless capsule endoscopy (CE) 6 years prior. Computed tomography enterography (CTE) demonstrated a 9 cm segment of active ileitis with an ileo-ileal fistula and a retained capsule
Figure 1
in the same segment. The patient underwent laparoscopic ileocolic resection at which time the capsule was removed (Fig. 1). CE is superior in evaluating small-bowel (SB) CD and suspected CD compared to other modalities including: push enteroscopy, colonoscopy with ileoscopy, small bowel radiography (SB), CTE, and MRE. 1 Strictures should preclude WCE unless a patency capsule proves adequate passing. A patency capsule should be considered prior to CE in any patient with suspected stricture. However, CE may detect strictures or small bowel disease not seen on conventional imaging. 2 The C-reactive protein and Crohn's disease activity index (CDAI) score may not correlate with active CD found on CE. 3 Nineteen patients with small bowel obstructive symptoms 5/19 (26%) were found to have a lesion on CE that was not present on a previous imaging study. 4 Retention in CD patients undergoing CE ranges from 5 to 13%. 5,6 Endoscopic or surgical intervention may be employed as the primary method for retrieving a retained capsule, however steroids and biologic agents have proven as effective when active
Laparoscopic ileocolic resection revealing the retained capsule.
1873-9946/$ - see front matter © 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.crohns.2012.12.009
e272 inflammatory non-stenotic CD is the etiology. 6 The risk of retention and surgery should be discussed prior to CE. This retained capsule was present in a CD patient for years prior to the development of symptoms. In patients new to a clinician or known to be non-compliant a patency capsule may prevent serious complications.
References 1. Dionisio P, Gurudu S, Leighton J, et al. Capsule endoscopy has a significantly higher diagnostic yield in patients with suspected and established small-bowel Crohn's disease: a meta-analysis. Am J Gastroenterol 2010;105:1240–8. 2. Mow WS, Lo SK, Targan SR, et al. Initial experience with wireless capsule enteroscopy in the diagnosis and management of inflammatory bowel disease. Clin Gastroenterol Hepatol 2004;2:31–40. 3. O'Donnell S, Qasim A, Ryan BM, et al. The role of capsule endoscopy in small bowel Crohn's disease. J Crohns Colitis 2009;3:282–6. 4. Cheifetz A, Lewis B. Capsule endoscopy retention: is it a complication? J Clin Gastroenterol 2006;40(8):688–91. 5. Voderholzer WA, Beinhoelzl J, Rogalla P, et al. Small bowel involvement in Crohn's disease: a prospective comparison of wireless capsule endoscopy and computer tomography enteroclysis. Gut 2005;54:323–6. 6. Cheifetz A, Kornbluth A, Legnani P, et al. The risk of retention of the capsule endoscope in patients with known or suspected Crohn's disease. Am J Gastroenterol 2006;101: 2218–22.
Letter to the Editor
Seth Lipka Department of Medicine Nassau University Medical Center, East Meadow, NY, United States Corresponding author. Tel.: + 1 2178984759; fax: + 1 2174290076. E-mail address:
[email protected]. Anthony Vacchio Long Island Clinical Research Associates, Great Neck, NY, United States Seymour Katz Clinical Professor of Medicine, New York University School of Medicine, New York, New York, United States North Shore University Hospital-Long Island Jewish Health System, Manhasset, NY, United States St Francis Hospital, Roslyn, NY, United States Lev Ginzburg Nassau Gastroenterology Associates, Great Neck, NY, United States
19 December 2012
