A propósito de la retención de cápsula endoscópica: cómo prevenir, diagnosticar y manejar esta complicación

We would like to comment on the article by Dr. RoeschDietlen et al. about a patient with Peutz-Jeghers syndrome, in which a video capsule (VC) was associated with bowel obstruction. VC retention is the most dreaded event in capsule endoscopy. Overall prevalence is around 2%. There are risk factors associated with greater frequency: a) suspicion of bowel stricture, b) chronic NSAID use, c) suspicion of tumor, and d) Crohn’s disease. In those cases, a prior imaging study is recommended to evaluate the permeability of the small bowel. Computed tomography with oral contrast (‘‘enteric phase’’ CAT) has greater sensitivity and specificity than bowel transit with barium. However, there is no absolute certainty, given that stricture and capsule retention have been reported, even when imaging studies are normal. Thus, some authors recommend the reabsorbable Agile capsule, but it is not available in Mexico and its results are controversial. Furthermore, capsule retention is usually asymptomatic and impaction (the term used to describe the lodging of the capsule in the stricture that results in complete bowel obstruction, as was the case of the patient in the article under discussion) is rare, and dependent on the severity of the stricture. The site and nature of the lesion is generally revealed through the retention, enabling the planning of an elective approach. One third of patients are reported to undergo single-balloon or double-balloon enteroscopy or a surgical intervention to simultaneously recover the capsule and treat the cause of the stricture before symptoms develop. The rest of the patients receive medical treatment