Cardiac devices, capsule don't interfere

The largest study to date regarding capsule endoscopy in patients with implanted cardiac devices suggested that neither type of device interferes with the other.

A retrospective analysis of 91 capsule endoscopies performed in 84 patients with implanted cardiac devices found no interference with operation of the cardiac devices and no interference with the capsule endoscopy imaging, reported at the annual meeting of the American College of Gastroenterology.

The implanted cardiac devices included a pacemaker alone in 63 of the endoscopies, a pacemaker plus an implantable cardioverter defibrillator (ICD) in 17 procedures, an ICD alone in 6, a left ventricular assist device (LVAD) in 3, an LVAD plus an ICD in 1, and a pacemaker plus LVAD in 1 of the procedures.

A physician in the audience noted that the size of the study was too small statistically to determine confidence intervals that would support definitive conclusions, would suspect that your conclusion is correct, that there is a major interference, and it’s reassuring.

“Going forward, we’ll continue to gather data on patients,” responded, assistant professor of medicine, department of gastroenterology and hepatology, the Mayo Clinic, Scottsdale, Ariz.

During one capsule endoscopy in a patient with an ICD, a 25-minute loss in capsule imaging was traced to a defective recorder in the capsule device and was not caused by interference from the ICD device. Imaging resumed when the recorder was replaced.

The findings suggest that capsule endoscopy is safe in patients with implanted cardiac devices, which may be particularly important for elderly patients. Elderly patients are most likely to have implanted cardiac devices and not uncommonly develop occult GI bleeding, which is the most common indication for capsule endoscopy.

In the study patients, 67 capsule endoscopies were performed to investigate GI bleeding, 14 were done for anemia, 6 for abdominal pain, 2 for celiac disease, and 1 each for diarrhea and Crohn’s disease.

About two-thirds (67 percent) of the patients were male and the average age was 73 years, ranging from 21 to 93 years.

Capsule endoscopy uses a miniature wireless capsule that is swallowed by the patient to perform diagnostic studies of the GI tract. The patients wears a recorder around the waist that receives images from the capsule as it travels through the digestive tract.

The quality of the bowel preparation for capsule endoscopy was considered fair to excellent in 48 percent of patients. Capsules reached the cecum in 62 percent.

The implanted cardiac devices were from 10 manufacturers, and primarily used bipolar programming, which is thought to be safer for patients with these devices who are undergoing capsule endoscopy.