Video Capsule Endoscopy after Bariatric Surgery: A Tertiary Referral Center Experience

Abstract

Background and aim: Minimal data is available regarding the performance of video capsule endoscopy (VCE) in patients that underwent bariatric surgery. We aim to report indications, feasibility and safety of VCE performed after bariatric surgery, specifically focusing on diagnosis rates of Crohn’s disease (CD) in this population. Methods: A retrospective analysis of all VCE procedures performed between January 2015 to December 2019. All patients that underwent bariatric surgery prior to VCE were included. Indication for VCE, Ingestion methods, completion rates, retention rates, and endoscopic findings were recorded. Results: A total of 1255 patients underwent VCE examination during the study period, of which 31 (2.5%) underwent bariatric surgery prior to VCE. The most common bariatric surgery was laparoscopic sleeve gastrectomy (16 patients, 51.6%) and the most common indication for VCE was evaluation of iron deficiency anemia (14 patients, 45.1%). The majority of patient ingested the capsule independently, without endoscopic assistance (20, 64.5%). Although patency capsule was not used in our cohort, no events of capsule retention were documented. Mean transit time was 4.32 hours. Only 4 events of incomplete examination were recorded. Over a median follow up of 27.5 months (IQR 13.0-34.2) 10 patients (31.2%) had a final diagnosis of CD with a median Lewis score of 225 (IQR 135-900). Conclusion: VCE is a feasible and safe procedure after bariatric surgery. Oral ingestion does not carry risk of retention. It is an effective means of diagnosis of small bowel CD in this population.

Diagnostic Challenges in Endoscopy

“…In bariatric patients presenting with iron deficiency anaemia, there is insufficient data to suggest whether video capsule endoscopy is safe for use. Peleg et al [4] demonstrated that video capsule endoscopy can potentially be used in patients post-sleeve gastrectomy with minimal adverse effects.…”