Case Study
Safety of capsule endoscopy in patients with pacemakers

https://doi.org/10.1016/S0016-5107(03)02879-7Get rights and content

Abstract

Background

Capsule endoscopy, a new technology, allows visualization of the entire small intestinal mucosa. The main indication for capsule endoscopy at present is the evaluation of GI bleeding of obscure origin. Studies to date suggest that capsule endoscopy is safe and is associated with few adverse events. One concern, which has not been studied, is the potential effect of the capsule on cardiac pacemakers and other electromedical devices. The primary aims of this study were to evaluate the safety of capsule endoscopy in patients with cardiac pacemakers who are being evaluated for GI bleeding of obscure origin and to determine whether pacemakers have any effect on the images captured by the capsule endoscope.

Methods

Patients with cardiac pacemakers referred for evaluation of GI bleeding of obscure origin were entered into the study. Before the procedure, an electrocardiogram was obtained, and pacemaker functions were checked. Capsule endoscopy was performed in a hospital setting to allow closer monitoring, instead of the outpatient clinic, which is our routine. Cardiac rhythm was assessed simultaneously during capsule endoscopy with a Holter monitor. Post-procedure pacemaker function was again checked for any disturbance. When the capsule endoscopy studies were reviewed, observations were made with particular reference to technical difficulty or interference with imaging.

Observations

Five consecutive patients (4 men, 1 woman; mean age, 73 years, range 56-92 years) with cardiac pacemakers were studied. In all patients, the indication for capsule endoscopy was GI bleeding of obscure origin. A cardiologist and pacemaker nurse specialist reviewed the Holter monitor recordings and evaluated pacemaker function after the procedure for each patient. No arrhythmia or other adverse cardiac event was noted during capsule transmission. No pacemaker-induced interference on the capsule endoscopy images was observed.

Conclusions

Capsule endoscopy appears to be safe in patients with cardiac pacemakers and does not appear to be associated with any significant adverse cardiac event. Pacemakers do not interfere with capsule imaging.

Section snippets

Patients and methods

All consecutive patients with cardiac pacemakers who were referred for CE were included in this observational study. An endoscopy assistant (a registered nurse) and a technician identified the patients, together with a cardiology registered nurse trained in pacemaker management. For each patient, a standard electrocardiogram was obtained, and pacemaker functions were checked at baseline evaluation. Cardiac rhythm was monitored during CE by means of a Holter monitor. After the procedure,

Observations

Five consecutive patients with cardiac pacemakers implanted for symptomatic bradyarrhythmias undergoing CE were studied. The indication for CE was GI bleeding of obscure origin in all cases.

The primary end point was any identified disturbance in pacemaker function during or immediately after CE. A cardiologist and pacemaker nurse specialist reviewed the Holter monitor recordings and checked pacemaker functions for each patient. Results of the pre- and post-procedure pacemaker checks and Holter

Discussion

Capsule endoscopy clearly has a place in the armamentarium for evaluation of certain GI disorders, especially GI bleeding of obscure origin.4 Many of the patients with these disorders are elderly, and some have underlying cardiac disease that requires pacemaker implantation. Therefore, it is of critical importance to know whether this new technology can be used safely in this group of patients.

Electromagnetic devices may interfere with the function of pacemakers.5., 6. Interference with ICDs

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