Risk of capsule retention in CD patients

January 28, 2020

Issue 02

Clinical Question

What is the risk of capsule endoscope retention in Crohn’s disease patients?

Editor’s Bottom Line

Video capsule endoscopy is a useful tool to evaluate small bowel Crohn’s disease. However, the capsule can be retained, and this risk is highest among adults with established disease. Routine pre-procedural evaluation of small bowel patency should be considered.

Reference

Pasha SF, Pennazio M, Rondonotti E, et al. Capsule Retention in Crohn’s Disease: A Meta-analysis. Inflamm Bowel Dis. 2020;26(1):33–42; https://doi.org/10.1093/ibd/izz083.

Synopsis

To determine rates of capsule endoscopy retention—a factor that limits widespread use of this technology—an international team of researchers conducted a meta-analysis of studies examining the use of capsule endoscopy in adult and pediatric Crohn’s disease patients. They found 35 high-quality studies published between 2000 and 2018 that met their criteria, with data on a total of 4,219 capsule endoscopies.

Findings revealed an overall 3.32% retention rate (95% Confidence Interval [CI], 2.62%–4.2%). More specifically, retention rates among those with established vs. suspected Crohn’s disease were 4.63% (95% CI, 3.42%–6.25%) and 2.35% (95% CI, 1.31%–4.19%), respectively. Retention rates among all adults were 3.49% (95% CI, 2.73%–4.46%), compared to 1.64% in pediatric patients (95% CI, 0.68%–3.89%). Adults with established disease were 3.4 times more likely than adults with suspected disease to experience capsule retention (Odds ratio: 3.4; 95% CI, 2.00%–5.67%) but there were no differences in retention rates between pediatric patients with established or suspected Crohn’s disease.

Capsule retention rates among those with established disease were lower if they had negative patency capsule testing (2.88%; 95% CI, 1.74%–4.74%) or small bowel imaging prior to capsule endoscopy (2.32%; 95% CI, 0.87%–6.03%).

Details

Study Design: Meta-analysis
Funding: Funded by Medtronic
Allocation: Not applicable
Setting: Multi-center
Level of Evidence: 3b (Oxford Levels of Evidence)