eP681 - Management of Retained Capsule Endoscopy: A Case Series and Literature Review

Purpose/Background: Since its introduction in 2000, video capsule endoscopy (VCE) has evolved to become the gold standard for evaluating small bowel diseases. Its most common applications include investigation of Crohn’s disease (CD) and occult gastrointestinal (GI) bleeding. The main risk associated with implementation of VCE is capsule retention (CR). The incidence of CR is between 0.3% - 2.5% across a range of indications with the most common site of retention being the ileum. Prolonged CR is associated with obstruction, perforation, and scarring resulting in the need for intervention. Here, we describe two cases of CR and our management. We then review the literature on management of CR.Methods/Interventions: Case #1A 73-year-old male presented to an outside facility in September 2022 with Crohn’s related ileal stricture and perforation. The patient underwent exploratory laparotomy with resection of the involved segment and reanastomosis. Two months later, the patient underwent VCE for evaluation of his CD which was retained in the terminal ileum. After failing a course of medical management and endoscopic intervention, the patient was referred to our clinic for surgical intervention. We performed a robotic ileocolectomy with reanastomosis – successfully retrieving the retained capsule which was located at the site of his strictured anastomosis. Case #2A 72-year-old female underwent VCE as part of a workup for chronic anemia in February 2023 which was retained in the ileum. After failing endoscopic management, the patient was referred to our clinic for surgical intervention. We performed a laparoscopic small bowel resection and successfully retrieved the capsule which was found to be immobilized at the site of a previously undiscovered Meckel’s diverticulum.Results/Outcomes: Both patients have been followed post-operatively and have recovered from surgical intervention without incident.Conclusion/

Discussion: Careful patient selection and utilization of a patency capsule may reduce the risk of CR. Conservative approaches to management of CR have been utilized with varying levels of success. A review of the literature reveals that 15%-52% of CR cases resolve without procedural intervention. Steroids and laxatives present helpful medical adjuncts. In patients who fail observation and medical management, double balloon endoscopy has proven to be a safe and reliable technique for retrieval of retained capsules. Surgical management is indicated in the setting of failed endoscopic or medical management and in patients presenting with acute obstruction or bleeding. A variety of surgical approaches have been described, but to the author’s knowledge this is the first published description of a robotic surgical retrieval technique to address CR."Case 1: Resected Bowel Segment and Retained Capsule

Case 2: Radiographic Appearance of Retained Capsule

Case 2: Meckel's Diverticulum

Case 2: Retained Capsule In Relation to Meckel's Diverticulum
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