A Case of Video Capsule Retention in a Rare Epiphrenic Diverticulum

Abstract

Purpose: Video capsule endoscopy (VCE) is a minimally invasive method of visualizing the small bowel. Capsule retention is the most common complication of VCE. While VCE retention has been described in various anatomical locations, there are no known reports of retention in an epiphrenic esophageal diverticulum. A 73-year old African-American female, with a long history of iron deficiency anemia, presented for evaluation of obscure gastrointestinal bleeding with VCE. She denied melena, hematochezia, abdominal pain, or dizziness. Her physical exam was unremarkable, with a negative in-office fecal occult blood test. On presentation to our clinic the patient was noted to have hemoglobin and hematocrit values of 9.9g/dL and 29.9%, respectively. VCE was performed using a PillCam SB (Given Imaging, Yoqneam, Israel). After 8 hours of recording, the capsule was noted to be halted in the esophagus. Further evaluation with an esophagram showed a large epiphenic esophageal diverticulum and diffuse esophageal spasms with poor peristalsis. The retained capsule was not observed in this study. The patient remained completely asymptomatic during this time. She underwent a second VCE study, this time with endoscopic deployment of the video capsule. The EGD confirmed a large epiphrenic diverticulum just above the gastroesophageal (GE) junction and a small hiatal hernia. The initial retained capsule, however, was not seen during the EGD and was presumed to have spontaneously passed. To our knowledge, this is the first case of video capsule retention in an epiphrenic esophageal diverticulum, likely due to their rarity. Our case suggests that esophageal diverticula may be a relative contraindication for VCE. In patients with hyper or hypomotility disorders, which are commonly associated with other anatomical problems within the GI tract, endoscopic deployment of the VCE beyond the diverticulum is a much safer alternative. Moreover, symptomatic patients may benefit from diagnostic work-up of esophageal and other GI tract diverticula as a preventative measure of capsule retention.Figure: Esophagram showing distal esophageal diverticulum (epiphrenic diverticulum).