Retention of Endoscopic Capsules in Diverticula: A Literature Review of a Capsule Endoscopy Rarity.

Aims: This review aims to provide an updated and comprehensive reviewof capsule retention within diverticula, shedding light on the characteristics and management of this rare event in capsule endoscopy. Methods: A systematic literature search was conducted across multiple databases. All observational studies that reported capsule retention in a diverticulum among complication and outcomes, as well as case reports and series, were included. Manual cross-checking of references was also performed. Three extractors performed abstract and full-text reviews, as well as data-extraction. Results: We found 167 references from Pubmed, Embase and Web Of Science, 65 duplicates were removed and further 71 references were excluded. Crosschecking of references found additional two articles. In total, 32 articles were included, resulting in a total of 34 cases of retained capsules in diverticula. The median age was 69 and the majority were male (76,5%). The most common retention occurred in Meckel’s diverticulum (32,4%) followed by Zenker’s diverticulum (20,6%). Investigation of capsule retention was done with X-ray (50%) and CT scan (44,1%). 17 cases (50%) were asymptomatic. Resolution of the retention happened with endoscopy (35,3%) and surgical management (32,4%), as well as self-resolution (20,6%). Conclusion: Due to the small number of cases, diverticula are not a risk factor for incomplete capsule endoscopy examination. It affects mainly elderly, male, asymptomatic patients, and are typically diagnosed using X-ray and CT scans. The most common type is Meckel’s diverticulum, and endoscopy was the primary management. Capsule endoscopy retentions are extremely rare, with only 34 cases reported since its introduction.