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Introduction: Capsule endoscopy (CE) has become a first-line tool for small bowel (SB) examination. However, adverse events (AEs), such as CE retention or aspiration, may occur. The aims of this study were to evaluate incidence, clinical outcomes and therapeutic approaches of CE-related AEs in the largest series published to date. Methods: Data from 5428 procedures performed at 12 institutions between August 2001 and January 2012 were retrospectively analyzed. Baseline patient characteristics; procedure; type, localization and symptoms before/after AEs; previous patency tests performed; therapeutic management and patient´s outcome were recorded. Results: The overall incidence of CE-related AEs was 1.9%: 2.0% for SB, 0.9% for esophageal and 0.5% for colon CE. The incidence of capsule retention was significantly higher than capsule aspiration (1.87% vs. 0.003%; p < 0.05), in patients suffering from inflammatory bowel disease (IBD) than in obscure GI bleeding (OGIB) (3.3% vs. 1.5%; p < 0.05) and in patients with the combination of nausea/vomiting, abdominal pain and distension. The SB was the most frequent localization of retention (88.2%). The use of patency tests -except for Patency© capsule- before CE was not a good predictor for AEs. Most of the patients with AEs developed no or mild symptoms (97%) and were managed by non-surgical methods (64.4%). Conclusions: CE-related AEs are uncommon and difficult to predict by imagiological examinations. SB retention, that is usually asymptomatic, is the most frequent AE. In absence of symptoms, non-surgical management of CE-related AEs is recommended.

A 56-year-old woman with positive genetic testing of hereditary nonpolyposis colorectal cancer (HNPCC), many familiarhistory of different neoplasia (Fig. 1), and a personal history of hysterectomy due to an endometrial cancer was referred toour Unit because of anemia with a positive fecal occult blood test. Both, gastroscopy and colonoscopy were performed withthe only result of less than 10 hyperplastic colonic polyps without signs of recent bleeding. An abdominal CT was also per-formed and was completely normal. According to these results, it was indicated a capsule endoscopy that showed a stenoticpolypoid lesion near of the Treitz angle. The capsule stayed retained and its battery went off at this point. With the objectiv eof making a histological diagnosis and removing the capsule endoscopy, a double balloon endoscopy was performed, and