Introduction: Wireless motility capsule may be used for evaluation of gastric emptying in gastroparesis, colonic transit in constipation and evaluation of generalized dysmotility. Capsule retention, though rare (0.33%), can occur especially if the contraindications for this test are not carefully ruled out before ordering the test.
Case Description/Methods: A 37-year-old woman was evaluated for suspected gastroparesis with nausea, heartburn and constipation. She reported bowel movements every 2 weeks (Bristol Stool Scale Type I-III) with excessive straining. She was taking pantoprazole, famotidine, promethazine, and bisacodyl. Her history included esophageal stricture requiring dilation 3 years previously, type 1 diabetes mellitus, and end stage renal disease (post kidney and pancreas transplant). She reported intermittent dysphagia for solids. A wireless motility capsule (WMC) study was performed for the evaluation of gastrointestinal motility disorder. The WMC profile is shown in figure 1A. The horizontal axis shows time scale and the vertical axis shows pressure (red), pH (green) and temperature (blue). The pH was 5-7 with occasional decreases to 2.0 coinciding with drinks/meals, indicating esophageal capsule retention. Ten hours later, the patient vomited and expelled the capsule, confirmed by a temperature decline. A week later, an upper endoscopy confirmed distal esophageal stricture (figure 1B) with mucosal changes of esophagitis. Pantoprazole was increased to twice daily and repeat esophagogastroduodenoscopy in 8 weeks was recommended.
Discussion: WMC offers a radiation-free, office-based assessment of gastrointestinal transit in patients with symptoms suggestive of gastrointestinal motility disorders. WMC may decrease the need for multiple tests, lead to new diagnoses and help with patients’ management. However, WMC study is contraindicated in patients with dysphagia, stricture or bowel obstruction. The test was incorrectly requested for the patient presented here but fortunately the patient vomited the capsule. In patients with dysphagia, stricture or bowel obstruction, gastrointestinal dysmotility symptoms should be evaluated using alternative tests such as scintigraphy. Although WMC is a significant advance and clinically useful for the diagnosis of gastrointestinal motility disorders, the manufacturer’s recommendations and precautions should be followed carefully to prevent potentially serious complications.
Figure: Figure 1: Wireless motility capsule profile of the patients (Figure 1A). The horizontal axis shows time scale and the vertical axis shows pressure (red), pH (green) and temperature (blue). The pH was 5-7 with occasional decreases to 2.0 coinciding with drinks/meals, indicating esophageal capsule retention. Ten hours later, the patient vomited and expelled the capsule, confirmed by a temperature decline. Subsequent upper endoscopy confirming distal esophageal stricture (figure 1B) with mucosal changes of esophagitis.
Disclosures: Liana Mosley indicated no relevant financial relationships. Asad Jehangir indicated no relevant financial relationships. Subbaramia Sridhar indicated no relevant financial relationships. Amol Sharma indicated no relevant financial relationships. Satish Rao indicated no relevant financial relationships.
Liana Mosley, MD1, Asad Jehangir, MBBS1, Subbaramia Sridhar, MBBS, MPH, FRCP, FRCPC, FACG2, Amol Sharma, MD3, Satish Rao, MD, PhD1. P2489 - Be Smart When Ordering SmartPill!, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
