title: The risk of retention of the capsule endoscope in patients with known or suspected Crohn's disease.
abstract: OBJECTIVE
  Capsule endoscopy (CE) allows visualization of the mucosa of the entire small bowel and is therefore a potentially important tool in the evaluation of patients with known or suspected Crohn's disease (CD). However, small bowel strictures, which are not uncommon in Crohn's, are considered to be a contraindication to CE for fear of capsule retention. Our goal was to determine the risk of capsule retention in patients with suspected or known CD.
  
  
  METHODS
  We retrospectively reviewed the records of 983 CE cases performed at three private gastroenterology practices between December 2000 and December 2003, and selected those with suspected or proven Crohn's.
  
  
  RESULTS
  A total of 102 cases were identified in which CE was used in patients with suspected (N = 64) or known (N = 38) CD. Only one of 64 patients (1.6%) with suspected CD had a retained capsule. However, in five of 38 (13%) patients with known Crohn's, the capsule was retained proximal to a stricture. Of the five cases of retained capsules, three strictures were previously unknown. In four cases, the obstructing lesions were resected without complications, leading to complete resolution of the patient's underlying symptoms. One patient chose not to undergo surgery and has remained without an episode of small bowel obstruction for over 38 months.
  
  
  CONCLUSIONS
  Capsule retention occurred in 13% (95% CI 5.6%-28%) of patients with known CD, but only in 1.6% (95% CI 0.2%-10%) with suspected Crohn's. A retained capsule may indicate unsuspected strictures in Crohn's that may require an unexpected, but therapeutic, surgical intervention. Patients and physicians should be aware of these potential risks when using CE in CD.
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Cheifetz
authors.forename: Asher A
authors.initials: AA
authors.lastname: Kornbluth
authors.forename: Peter
authors.initials: P
authors.lastname: Legnani
authors.forename: Ira
authors.initials: I
authors.lastname: Schmelkin
authors.forename: Alphonso
authors.initials: A
authors.lastname: Brown
authors.forename: Simon
authors.initials: S
authors.lastname: Lichtiger
authors.forename: Blair S
authors.initials: BS
authors.lastname: Lewis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D053705:Capsule Endoscopes / Q000009:adverse effects*; D053704:Capsule Endoscopy; D002648:Child; D015331:Cohort Studies; D003424:Crohn Disease / Q000473:pathology*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment