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Page 4 of 7 O’Grady et al. Mini-invasive Surg 2022;6:34 https://dx.doi.org/10.20517/2574-1225.2022.22

ensure its integrity and paired with a recording device, is then swallowed with water containing Simethicone
to aid small bowel mucosal views. Following confirmation that the capsule has entered the stomach, the
patient remains fasting for a further 2 h, after which water may be consumed, followed by solid food from 4
h. Post-procedure, the capsule data are reviewed and cases where the capsule has not reached the caecum by
the end of the recording window are flagged for follow-up 14-day PFA to evaluate capsule retention [2,4,5] .

The current practice for upper gastrointestinal tract capsules where the capsule is unlikely to be seen to
reach the caecum given the shorter recording time and protocol variation is to advise patients to attend the
hospital if they experience any abdominal symptoms suggestive of capsule retention or obstruction.
Additionally, a PFA is advised prior to a future MRI to ensure the capsule has passed.

RESULTS
During the five-year study period, 688 small bowel VCE were performed. Of these, 3.6% (25/688)
underwent prior patency capsule testing. All patients who required patency capsules during this study
period were deemed suitable to proceed with capsule endoscopy. Cases where there was clear video
evidence of capsule hold-up or significant small bowel pathology on the video recording were excluded
from primary analysis.

Twenty-eight cases were identified where the capsule was not seen to reach the large bowel within the
recording window. Of these, 15 cases were female and the median age was 53.5 years (range 23-85 years). In
total, 31 PFAs were performed to investigate possible capsule retention, none of which demonstrated
definitive evidence of capsule retention [Figure 2]. Two patients underwent a second PFA as the first did
not demonstrate clear capsule progression, although both patients remained asymptomatic. The capsule was
demonstrated in the large bowel or was excreted on repeat PFA. A third patient had a repeat PFA due to a
metal artifact in the abdomen, which was deemed unrelated to the capsule which had been excreted. In only
one case where the video capsule could not be confirmed to reach the caecum did a patient report
abdominal pain post VCE. Subsequent PFA demonstrated the capsule had been excreted.

Of the cases that underwent follow-up PFA to assess for capsule retention, ten VCE studies were indicated
to evaluate small bowel inflammatory bowel disease (IBD), seven for investigation of iron deficiency
anemia, one for polyp surveillance in Peutz-Jeghers syndrome, and one to further investigate abnormal
terminal ileum thickening on cross-sectional imaging. The remaining nine cases were referred from external
services and access to indication was unavailable. None of these video capsule cases identified findings
consistent with an obstructing lesion, stricture, or other concerning features that would potentially result in
capsule retention.

DISCUSSION
Our data show no cases of unexpected capsule retention identified over a five-year period, with 688 small
bowel video capsule endoscopies performed. In addition, our patency capsule rate was 3.6%, used in
addition to cross-sectional imaging to help determine the risk of capsule retention.

Our data compare favorably with previous studies where capsule retention rates are estimated to be
[6]
[3]
1.2%-4.63% . In the absence of obstructive symptoms, capsule retention risk is estimated lower at 0.3% .
Our findings may be explained, in part, by the exclusion of cases where significant pathology or capsule
hold-up in the small bowel was identified on the capsule recording. This was done as our study aim was to
assess the utility of 14-day PFA follow-up of asymptomatic cases where the capsule has not clearly reached
the colon during recording, as currently recommended . With no such cases of capsule retention identified
[2]