The Use of Wireless Capsule Endoscopy in Community Practice: An 11 Year Experience

Abstract

BACKGROUND: The role of wireless capsule endoscopy (WCE) in small bowel Crohn's disease (SBCD) has been studied in many clinical trials and has been shown to be superior to other modalities (eg, barium radiography, colonoscopy with ileoscopy, computed tomography enterography, push enteroscopy) for diagnosing and evaluating non-stricturing SBCD. There have been concerns about the risk of capsule retention in SBCD because of small bowel strictures, with reported capsule retention rates in patients with known SBCD as high as 13% (range 4-13). Our purpose is to demonstrate the safety of WCE in patients with known or suspected SBCD in our community based, private practice that specializes in inflammatory bowel disease (IBD). METHOD(S): We performed a retrospective chart review of patients with confirmed SBCD who had undergone WCE between 2001 and 2012. Patients with documented bowel obstruction; radiographic or endoscopic evidence of strictures <1 cm in diameter; history of bowel obstruction, stenotic surgical hookups, or intestinal scarring were excluded from undergoing WCE per facility protocol. All patients had either a computed tomographic enterography, magnetic resonance enterography or small bowel follow-through in addition to careful pre-screening history and physical exam to evaluate for WCE exclusion criteria prior to any capsule swallow. RESULT(S): Ninety four patients with confirmed SBCD underwent WCE and were included in the study; 44% (n = 43) males, 56% (n = 51) females with a mean age of 46, and mean disease duration of 7.54 years (range <1-46). Forty seven patients (50%) had CD for <1 year in duration at the time of WCE, and the majority had mild-to-moderate CD. Of the 94 patients, 23 patients had serial capsule studies for reassessment during the 11 year study period, with a total of 42 WCE studies done on this population. Of the 94 patients, and 136 separate studies only 1 capsule was retained (0.7%) in this 11 year period. This retained capsule was easily removed by endoscopy from a duodenal stricture. CONCLUSION(S): WCE can be safely performed in SBCD patients, as evidenced by our single center, community IBD practice performing 136 WCE procedures on 94 patients revealing only one single retention event. We believe that careful selection of appropriate patients allows for the safe use of WCE technology in patients with SBCD. By having a single expert physician in inflammatory bowel disease evaluate and prescreen each patient with a carefully taken medical history, physical exam, and use of radiography prior to WCE, the risk of capsule retention in this population is minimized.