S0522 Incomplete Capsule Endoscopy: Does a Repeat Endoscopically Placed Capsule Solve the Problem?

INTRODUCTION: Video capsule endoscopy is an effective method for imaging the small intestine, which is otherwise difficult with standard endoscopy. However, capsules often fail to completely traverse the small bowel. Known risk factors for capsule retention include gastroparesis, dysmotility, use of opiates, and strictures. The primary objective of this study was to assess whether endoscopic deployment of the capsule in patients who underwent previous incomplete capsule endoscopy improves the completion rate of a repeat study. METHODS: IRB exemption was obtained from Thomas Jefferson University. The medical records of all patients who underwent initial capsule endoscopy between 1/1/2018 and 5/1/2020 were reviewed. Exclusion criteria included complete initial capsule endoscopy, failed capsule studies that were not repeated, technical failures, and initial capsules endoscopically placed in the stomach. Patients with repeat capsule endoscopy within 60 days of failed capsule endoscopy for the same indication were analyzed (Figure 1). A study was considered complete when the capsule fully traversed the small bowel. Predictors for the completion of capsule endoscopy were analyzed with the Fischer’s exact test. The etiologies of failed studies were recorded. RESULTS: 32 repeat capsule endoscopies were eligible for inclusion in this study. The etiology for the failure of initial endoscopy was noted for each patient (Table 1). 87% of incomplete, orally ingested capsule studies resulted from retention in the stomach. Demographic factors, medical comorbidities, and whether capsules were orally ingested or endoscopically placed were analyzed as potential predictors for the completion of repeat capsule endoscopy (Table 2). In patients with previously failed swallowed study, repeat endoscopic capsule placement was more likely to result in success (P = 0.0395). Repeat endoscopic capsule placement was more likely to be successful when the patient had previously failed a swallowed study compared to an endoscopically placed capsule study (P = 0.043). CONCLUSION: While most capsule endoscopies are successful on the first attempt, this study provides data to help guide gastroenterologists' approach to repeat capsule endoscopy. Specifically, our results indicate that endoscopic placement of the repeat capsule helps to avoid the most frequent mode of failure after oral ingestion, retention in the stomach, and is effective in improving the completion rate of the repeat study.Figure 1.: Study inclusion flow diagram.Table 1.: Causality of failed initial capsule endoscopyTable 2.: Univariate analysis of factors influencing completion of repeat capsule endoscopy