Limitations in Capsule Endoscopy Examinations

Aim: To evaluate the frequency and clinical relevance of events that supposed a limitation for capsule endoscopy (CE) examination in our series. Methods: We analyzed the first 533 examinations from our series. CE examination limitations were divided into: technical limitations, if they affected the normal function of any of the components of the diagnostic system; and clinical limitations, if they were related to physiological or pathological conditions of the patient. In every case we documented the cause of the limitation and whether it affected or not the validity of the examination depending on its indication. Results: 86 (16.13%) limitations were observed, preventing the fulfillment of the indication in 32 (6.00%). 26/86 (30.25%) of them were technical limitations, 13/26 were battery-related problems, 8/26 problems related to recording, 3/26 due to impossibility to activate the CE and 2/24 related to errors during examination download. Technical limitations prevented a diagnosis in 11/26 (42.30%) cases. We found clinical limitations in 60/86 (69.76%) examinations. In 2/60 endoscopic insertion of the capsule was necessary. Small bowel was not reached during a normal battery life in 32/60, in those cases the capsule was expulsed later without problems. In 14/48 the ileoceccal valve was visualized but not crossed during the examination while in 18/48 the ileoceccal valve was not visualized; delayed gastric emptying could explain 14/32 of those cases. Capsule retention occurred in 13/60 (2.43% in series total) cases: 4 due to NSAID related strictures, 3 due to post-radiation therapy strictures, 4 were strictures in Crohn's patients and the last 2 because of malignant tumors. 4/13 (30.75%) of those patients underwent surgery. Clinical limitations prevented the fulfillment of the indication in 22/60 (36.66%) cases. Conclusions: Limitations are not frequent and rarely prevent the fulfillment of the examination indication. Most of them were clinical limitations. Technical limitations were more common in the early experience of CE. Capsule retention is rare and requires surgery in less than the third of the cases.