Capsule endoscopy aspiration and respiratory physician's treatment insights: a case report and literature review

Background

Capsule endoscopy (CE) is widely used for intestinal examination; however, capsule aspiration into the airway is a serious complication that requires urgent intervention. We present a management case report and review 39 cases from 2003 to 2023, providing insights into the prevention and treatment of capsule aspiration.

Case presentation

A 69-year-old man with chronic bronchitis and emphysema presented with 7 months of intermittent melena. After swallowing a capsule endoscope (PillCam™ SB 3), he had a brief cough and chest tightness. Imaging confirmed aspiration in the right intermediate bronchus, and non-invasive removal procedures were unsuccessful.

Methods

Real-time imaging confirmed the lodged capsule. Non-invasive methods, such as coughing and chest percussion, were unsuccessful. Therefore, flexible bronchoscopy was performed under general anesthesia to retrieve the capsule using a snare, which was then placed into the duodenum using a gastroscope.

Results

The capsule was successfully retrieved, and the patient recovered well, completing the endoscopy without further issues.

Conclusion

Our case study and literature review highlight the need for careful attention to high-risk groups in CE, including the elderly and individuals with neurological or swallowing difficulties. A thorough history review and real-time monitoring are essential for preventing complications. Bronchoscopy is preferred for CE retrieval due to its advantages. Manufacturers are urged to improve CE safety, with respiratory physicians helping internists in managing this potentially life-threatening complication.

Short article: Aspiration of capsule endoscopes: a comprehensive review of the existing literature

INTRODUCTION

Capsule endoscopy (CE) has an excellent safety profile. Although retention is the most cited complication, capsule aspiration is less frequent and is often reported only as isolated cases. This study represents a systematic effort to compile and scrutinize the available data on capsule aspiration to provide comprehensive and conclusive information on this CE complication.

MATERIALS AND METHODS

A systematic literature search was performed in PubMed, Embase and Chinese National Knowledge Infrastructure. The search terms used were 'capsule endoscopy' AND 'aspiration' (both terms searched as keyword and MeSH). We included case reports and/or series on capsule aspiration, as well as observational cohort studies that reported capsule aspiration among their complications/outcomes.

RESULTS

Thirty-four case reports with 37 cases of capsule aspiration were identified. A further four observational studies reported aspiration as part of a cohort of patients undergoing CE. 94.6% of aspirations occurred in elderly men. 87.1% had significant comorbidities. 59.5% had symptoms on aspiration, with cough reported most frequently. The most common location of aspiration was the right main bronchus. Half of the patients required intervention for capsule retrieval; bronchoscopy was the most common management, with good effect. There was a single fatality following capsule aspiration, not directly related to the procedure, and one case of aspiration pneumonia. Outcomes were good for all other patients. The estimated overall aspiration rate is 0.1%.

CONCLUSION

Although very rare and generally safely managed, capsule aspiration should be anticipated in certain patient groups and capsule administration should be approached with necessary precautions.