How would you manage an asymptomatic patient after VCE showing small bowel Crohn's who passes the patency capsule but has retained the video capsule in the distal ileum with minimal surrounding inflammation?

A capsule can take up to 10 days to pass in a normal situation. If you have radiographic evidence of a retained capsule and the patient is on prednisone, it might take another 2 weeks or so to get the inflammation down. Remember that the capsule should continue to get crushed and really should pass by then. A CTE will help tell you how much fibrosis is present after 4 weeks or so of prednisone. If there is significant fibrosis no amount of medication will reverse that and the patient should have a limited resection. You could send the patient to a center that performs balloon endoscopy to try to retrieve the capsule endoscopically.

If asymptomatic, the patient can be watched for long-term without the need for surgery. There have been cases of capsule retention for even up to a year, and I have had clinical experience of a patient with capsule retention for many years. IF the decision made is to wait and watch, then I would recommend the following: 1) notify the patient of risks vs. benefits (potential for obstruction and signs and symptoms to watch for), 2) consider optimizing therapy to ensure the inflammatory component is in remission.

If the decision is made for retrieval, and the patient remains asymptomatic, consider enteroscopic removal if feasible (Consider retrograde balloon enteroscopy or if the area can be reached by regular colonoscopy with endoscopic dilat...