CAPSULE BRONCHOSCOPY: A PILL ENDOSCOPY GONE WRONG

Abstract

SESSION TITLE: Case Report Semifinalists 4 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Capsule endoscopy has become increasingly utilized as a tool in the evaluation of occult gastrointestinal bleeding, small bowel diseases, tumors etc. The most common complication is retention of the capsule, which occurs in 1-8% of cases. However, as its use expands, the complication of aspiration has been occurring with increasing frequency. CASE PRESENTATION: An 85 year old man with a history of coronary artery disease and iron deficiency anemia was sent into the emergency department with foreign body aspiration. Five days prior to admission he had outpatient placement of a Pill Endoscope/PillCam© (11 mm x 26 mm). The day of admission the gastroenterologist reviewed the images, which revealed that the PillCam© was in the patient’s airways (image 1). Chest xray at admission showed a foreign body in the right main stem bronchus (image 2). Upon questioning, the patient stated that he was coughing since the Pillcam© was placed but did not recall having any difficulty swallowing it. However, he did state that he has been coughing while eating solids and liquids for several months. The patient underwent flexible bronchoscopy, which showed the PillCam© in the bronchus intermedius. The capsule was successfully removed with a snare (images 3 & 4). The patient underwent swallow evaluation while admitted and was found to have significant dysphagia, as well as a C3-C4 osteophyte and laryngopharyngeal reflux. DISCUSSION: As of 2017, 39 cases of capsule aspiration have been described in the literature and estimated to occur in 1/1,000 cases. Aspiration of the capsule is generally asymptomatic, but can cause symptoms of coughing and dyspnea but can be life threatening. No deaths have been reported related to aspiration of pill endoscopy. In addition, some capsules move into the esophagus spontaneously. However, the majority of patients require bronchoscopic intervention to retrieve the capsule. Aspiration has been shown to occur more frequently in older males without a history of swallowing disorders. Our patient appeared to be at high risk for aspiration of the capsule given his history. This reinforces the fact that patients should be carefully screened prior to placing the capsule, especially for dysphagia. In those cases, patients should be placed in the best position for swallowing with use of a real time viewer to ensure correct position of the capsule or alternatively, the capsule should be placed endoscopically. CONCLUSIONS: Aspiration of pill capsule endoscopy is a rare but possible complication that may require bronchoscopic intervention. Patients should be carefully screened for dysphagia prior to the procedure, especially in the high risk population. Reference #1: Yung, Diana E., John N. Plevris, and Anastasios Koulaouzidis. "Short article: Aspiration of capsule endoscopes: a comprehensive review of the existing literature.” European journal of gastroenterology & hepatology 29.4 (2017): 428-434. Reference #2: Buscot, Matthieu, et al. "Bronchial Aspiration of Capsule Endoscope.” Respiration 93.2 (2017): 122-125. DISCLOSURES: No relevant relationships by Abhinav Agrawal, source=Web Response No relevant relationships by Ayelet Hilewitz, source=Web Response no disclosure on file for Viera Lakticova