Diagnostic Yield, Completion Rate, and Adverse Events of Small-Bowel Capsule Endoscopy: A Single-Center Retrospective Study

Abstract

Aims: Capsule endoscopy (CE) has become an essential diagnostic tool for small-bowel evaluation. Despite its high diagnostic yield and safety profile, technical limitations and clinical complications may affect its performance. This study aimed to evaluate the diagnostic performance, limitations and complications of capsule endoscopy in real-world clinical practice. Study Design:  Single-centre retrospective study. Place and Duration of Study: Department of Digestive and Hepato-Gastroenterological Functional Explorations, Ibn Sina University Hospital, Rabat, between 2017 and 2025. Methodology: We conducted a single-centre retrospective study including 125 patients who underwent capsule endoscopy between 2017 and 2025 at the Department of Digestive and Hepato-Gastroenterological Functional Explorations, Ibn Sina University Hospital, Rabat. Indications included obscure gastrointestinal bleeding, suspected Crohn's disease or follow-up for Crohn's disease, coeliac disease, malabsorption, Rendu–Osler disease and suspected small-bowel lymphoma. Diagnostic yield was defined as the proportion of procedures that identified at least one clinically significant lesion capable of explaining the indication and guiding therapeutic management. Technical and clinical limitations were analysed, including incomplete examinations, capsule retention, ingestion difficulties and inadequate visualisation. Results: A total of 125 patients were included, with a mean age of 56.2 ± 19.6 years and a slight female predominance (54.4%). The main indication was obscure gastrointestinal bleeding (76.8%). Capsule endoscopy was completed in 110 of 124 performed procedures (88.7%). The overall diagnostic yield was 65%, with angiodysplasias being the most common finding (32.8%), followed by small-bowel ulcerations (17.6%). Clinical limitations were observed in 28% of cases. Incomplete examinations occurred in 11.2% of patients, whereas capsule retention occurred in 2.4%, mainly in patients with Crohn's disease. Technical failure was rare (0.8%). Inadequate visualisation occurred in 10.4% of procedures, mainly due to residual debris or intraluminal blood. Conclusion: In this single-centre retrospective cohort, capsule endoscopy appeared to be a safe and diagnostically useful modality for small-bowel evaluation, with a favourable safety profile. However, incomplete examinations, capsule retention and visualisation limitations remained important factors affecting diagnostic performance. Optimising patient selection and bowel preparation may further improve outcomes and enhance the clinical utility of capsule endoscopy.