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Robert Enns, MD,1 Drew Schembre, MD,2 John J Brandabur, MD2, Klaus Mergener, MD,2

Division of Gastroenterology, Dept of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia1 and Section of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington, USA2

BACKGROUND: Capsule endoscopy is a novel diagnostic method of imaging the gastrointestinal tract using a wireless capsule which transmits images to a data recorder while the device traverses the small intestine. Although the images are impressive; and the yield appears excellent, there are still technical short-coming that occur during the test.
OBJECTIVE: We reviewed our combined experience with capsule endoscopy to determine the limitations and complications of this device in our patients.
METHODS: Most patients are now prepared for capsule endoscopy with a single bottle of phosphasoda. Following an 8 hour fast, a sensor array system is applied to the abdomen, the capsule is swallowed and the images transmitted to a data recorder worn on the patient's side. Typically, the battery life of the capsule is 8 hours, following which the data recorder is returned, downloaded to a computer workstation and reviewed.
RESULTS: To date, 199 capsule studies have been performed in 180 patients. In 12 studies there was complete/near-complete capsule failure to transmit, 5 capsule had failed spontaneous excretion (2 removed endoscopically, 1 required surgery to remove, 1 found incidentally at surgery), 11 studies had poor visualization (usually food occluding the lumen; in several cases in patients on high-dose narcotics), the capsule became 'lodged' (extended period) with spontaneous passage in 5 cases, significant transmission gaps were seen in 12 studies and in 22 studies the capsule did not reach the cecum prior to end of battery life.
CONCLUSION: Although WCE has a high diagnostic yield for some conditions, both patients and physicians need to be aware of technical problems and other shortfalls.