Capsule retention in case of small bowel stenoses caused by non-steroidal anti-inflammatory drugs (NSAIDS): What to do?

Introduction: Results so far suggest that damage to the small bowel mucosa in patients permanently taking NSAIDs is a frequent side effect. Lesions may cause manifest or obscure bleeding, abdominal pain, obstruction or perforation. Based on small bowel capsule examinations carried out so far, the capsule is most frequently retained in patients permanently taking NSAIDs, in Crohn's disease or due to small bowel tumors, radiation enteritis and after previous abdominal surgery.

Patients and methods: We have carried out 576 small bowel wireless capsule endoscopy with different indications at our center from 2004 to April 2014 using Given Imaging's video capsule endoscopy. This study attempted to investigate the clinical outcomes of capsule retention.

Results: Permanent capsule retention occurred in 0.52% of total cases (3/576). In two patients capsule retention was caused by multiple stenoses due to NSAID. In the third patient a stenosis caused by radiation enteritis gave rise to the obstruction. The capsule was successfully mobilized in two patients following balloon dilatation by single-balloon enteroscopy. One of the stenoses caused by NSAID could not be reached during colo-enteroscopy, therefore surgical intervention was necessary.

Conclusions: Capsule endoscopy is absolutely justified to establish the diagnosis of NSAID enteropathy and exclude other diseases. Stenoses caused by NSAIDs tend to be short, wide-based or membranous, therefore the diagnostic yield of radiological examinations is rather limited. Single-balloon enteroscopy yielded effective results where strictures were able to be reached and expanded.