Safety and performance of small bowel capsule endoscopy in patients with surgically altered gastrointestinal anatomy

Background To study the performance and efficacy of small bowel capsule endoscopy (SBCE) in a large cohort of patients with surgically altered gastrointestinal anatomy (SAGA).Methods We retrospectively reviewed all SBCE studies between January 2000 and August 2025. Patients with SAGA (prior gastrectomy, gastric bypass, small bowel resections, esophagectomy, or Whipple procedures) were matched 1:2 to patients with native gastrointestinal (GI) anatomy. Primary outcome was SBCE completion rate. Secondary outcomes included diagnostic yield, capsule retention, and GI transit times.Results A total of 102 patients with SAGA were matched to 204 patients with native GI anatomy. Gastric bypass was the most common surgical history among SAGA patients (n = 47; 46%). Use of patency capsule prior to SBCE ingestion was more frequent in the SAGA group (27% vs. 6%, p < 0.01). The most common indication for SBCE was overt GI bleeding (SAGA 43% vs. native 60%, p = 0.01).Completion rates were similar (SAGA 95% vs. native 94%, p = 0.93). Capsule retention requiring endoscopic or surgical retrieval occurred only in the native anatomy group (n = 3). Median total transit time was shorter in the SAGA group (731 vs. 818 min, p < 0.01), while median small bowel transit time was similar between the groups. Overall diagnostic yield was similar between the groups (SAGA: 48% vs. native GI anatomy: 57.4%, p = 0.13).Conclusions SBCE is effective in patients with SAGA, demonstrating comparable completion rates and similar diagnostic yield to patients with native GI anatomy.