Capsule endoscopy regional transit abnormality: a sign of underlying small bowel pathology

Background. Wireless capsule endoscopy is being used increasingly to investigate GI bleeding of obscure etiology and other small bowel abnormalities. Currently, there is no standard for capsule endoscopy image interpretation and classification. Methods: This report describes an abnormality, termed "regional transit abnormality," noted during a review of capsule endoscopic images. Capsule regional transit abnormality simply refers to delayed capsule transit within a segment of small bowel, with or without visualization of a mucosal abnormality. The slowed transit usually is accompanied by mucosal collapse, sometimes with the appearance of the capsule pressing or impacting upon the mucosa. Regional transit abnormality usually persists more than 15 minutes. Observations: Four patients (of 30) with regional transit abnormality on capsule endoscopy had underlying small bowel pathology. There were two tumors, unseen by capsule endoscopy, that accounted for the presence of capsule regional transit abnormality. Conclusions: Capsule regional transit abnormality is considered to be a "red flag" sign that indicates a likelihood of some underlying small bowel pathology.