Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2016; 22(45): 9898-9908
Published online Dec 7, 2016. doi: 10.3748/wjg.v22.i45.9898
Contraindications for video capsule endoscopy
Dirk Bandorski, Niehls Kurniawan, Peter Baltes, Reinhard Hoeltgen, Matthias Hecker, Dominik Stunder, Martin Keuchel
Dirk Bandorski, Matthias Hecker, University of Giessen and Marburg Lung Center, Member of the German Center for Lung Research (DZL), 35392 Giessen, Germany
Niehls Kurniawan, Peter Baltes, Martin Keuchel, Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Glindersweg, 21029 Hamburg, Germany
Reinhard Hoeltgen, Klinikum Westmünsterland, St. Agnes-Hospital Bocholt Rhede, Medical Clinic 1 Cardiology/Electrophysiology, Barloer Weg, 46397 Bocholt, Germany
Dominik Stunder, Research Center for Bioelectromagnetic Interaction (femu), Institute of Occupational and Social Medicine, RWTH Aachen University Hospital, Pauwelsstrasse, 52074 Aachen, Germany
Author contributions: Each author wrote a part of the paper; Bandorski D and Stunder D analyzed technical data of capsule endoscopy and implantable cardiac devices.
Conflict-of-interest statement: Baltes P and Keuchel M have received lecture fees from Covidien, Medtronic, Olympus; the other authors have nothing to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dirk Bandorski, MD, FESC, FACC, University of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Klinikstrasse 33, 35392 Giessen, Germany.
Telephone: +49-641-98542351 Fax: +49-641-98542359
Received: August 27, 2016
Peer-review started: August 31, 2016
First decision: September 12, 2016
Revised: October 9, 2016
Accepted: November 14, 2016
Article in press: November 16, 2016
Published online: December 7, 2016
Processing time: 101 Days and 16.6 Hours

Video capsule endoscopy (VCE) has been applied in the last 15 years in an increasing field of applications. Although many contraindications have been put into perspective, some precautions still have to be considered. Known stenosis of the gastrointestinal tract is a clear contraindication for VCE unless surgery is already scheduled or at least has been considered as an optional treatment modality. In patients with a higher incidence of stenosis, as in an established diagnosis of Crohn’s disease, clinical signs of obstruction, prior radiation or surgical small bowel resection, a preceding test with the self-dissolving patency capsule can override this contraindication. Endoscopic placement of the capsule should be considered in patients with swallowing disorders to avoid aspiration. Esophageal or gastric motility disorders may require endoscopic capsule transport or application of prokinetics if the real-time viewer proofs delayed transit. In pregnant women, VCE should be restricted to urgent cases where diagnosis cannot be postponed after delivery, as data on safety are missing. There is theoretical and clinical evidence that patients with implanted cardiac devices such as a pacemaker, cardioverters or left heart assist devices, can safely undergo VCE in spite of still existing contraindication by manufacturers. Children from the age of 2 years have safely undergone VCE. Although video capsules are not proven safe with magnetic resonance imaging (MRI), first single cases of patients incidentally undergoing MRI with an incorporated capsule have been reported, showing susceptibility artifacts but no signs of clinical harm.

Keywords: Video capsule endoscopy, Contraindications, Stenosis, Pacemaker, Aspiration, Pregnancy, Magnetic resonance imaging

Core tip: Video capsule endoscopy has emerged as a first line diagnostic tool for small bowel visualization. The few existing contraindications are discussed in this review and put into perspective. Special situations are to be considered for patients with gastrointestinal stenosis, swallowing and motility disorders, or implanted electromagnetic cardiac devices, pregnant women, young children, and magnetic resonance imaging for patients with a retained capsule. Appropriate precautions are discussed in this paper.