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O’Grady et al. Mini-invasive Surg 2022;6:34 https://dx.doi.org/10.20517/2574-1225.2022.22 Page 5 of 7

Figure 2. The number of cases of video capsule endoscopy performed during the study period and the number of cases of retention
identified on 14-day plain film abdomen (PFA) follow-up.

on PFA, we suggest that routine follow-up PFA in these cases may no longer be required. This may reduce
the need for repeat patient attendance to hospital and, in addition, reduce the burden on radiology PFA
services and unnecessary radiation exposure for patients.

In the majority of cases of suspected capsule retention, particularly in the absence of obstructive symptoms,
[7]
conservative treatment options are often appropriate . The use of corticosteroids or immunomodulators
may result in spontaneous capsule excretion, particularly in cases of IBD . In a previous large retrospective
[3,8]
study of 2300 patients, including 196 with small bowel Crohn’s disease, capsule retention was seen in five
cases . In three of these cases, the capsule passed spontaneously after steroid therapy, with two patients
[8,9]
[8,9]
undergoing surgery for capsule retrieval . Furthermore, a 10-year retrospective study identified capsule
retention in 1% (25/2401) of cases, most commonly in cases of Crohn’s disease and occult gastrointestinal
[10]
bleeding . Previous gastrointestinal surgery was also found to correlate with the risk of retention, with an
[10]
odds ratio of 7.64 (95%CI: 3.45-16.93, P < 0.001) . Five of these cases required emergency endoscopic or
surgical removal. Notably, this study reports that symptoms had resolved for all cases of capsule retention
after follow-up or intervention, suggesting the presence of symptomatic capsule retention. Surgical
intervention is rarely required; endoscopic retrieval, such as device-assisted enteroscopy, may be
[3,7]
considered, but a conservative, observant approach is often sufficient in the absence of symptoms .
We suggest that careful history taking and referral screening helps identify and reduce the risk of capsule
retention in patients undergoing VCE. In addition, the appropriate use of cross-sectional imaging and
patency capsule testing further reduces the risk of both symptomatic and asymptomatic capsule
retention [8,11] . Our study is limited, however, as a retrospective review and access to some external referral
data were unavailable. As mentioned above, cases with clear evidence of luminal pathology on video
recording and capsule hold-up were not included in the analysis and underwent specific intervention and
management. In the future, information booklets for patients with advice to seek urgent medical attention