PILL ASPIRATION: BRONCHOSCOPIC CHARACTERISTICS OF IRON ASPIRATION COMPARED TO OTHER PILLS

Abstract

SESSION TITLE: Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Pill aspiration is a rare but potentially serious event that can lead to airway damage. Case reports describe instances of iron pill aspiration, however series comparing iron and non-iron pill aspiration are lacking. Here we examined cases of pill aspiration managed with flexible bronchoscopy to describe the differences in clinical characteristics and degree of airway inflammation among patients aspirating iron and non-iron pills. METHODS: A single-center retrospective observational study was conducted at the Mayo Clinic in Rochester, MN. All cases of pill aspiration occurring between 2008 and 2020 were examined. Patient characteristics and bronchoscopy findings were gathered. The severity of inflammation was graded as mild, moderate, or severe based on the bronchoscopists’ operative notes. RESULTS: A total of 28 cases of pill aspiration were reviewed, nine of which were iron sulfate pill aspiration. Among the non-iron group, the various pills aspirated included magnesium sulfate, docusate, multivitamins, calcium carbonate, pantoprazole, nortriptyline, garcinia cambogia, and morphine. No definite identification of the pills could be made in nine cases, but was deemed to definitely not be iron based on the patients’ medication list. In the non-iron group, the mean age was 69 (SD = 16.8). 68% were female. The duration between the aspiration event and the bronchoscopy procedure was identified in 17 cases; the mean duration was 1.81 days (SD = 2.1). Pill material was visualized in 11 cases and in three of the cases, the entire pill was removed intact. 21% of the cases were noted to have severe inflammation and the remaining had mild or moderate inflammation as deemed by the operating bronchoscopists. In the iron group, the mean age was 72 (SD 9.6). 100% were female. The duration between aspiration and bronchoscopy was identified in seven cases; the mean duration was 2.28 days (SD = 2.3). Pill material was visualized in five cases. 78% of the cases were noted to have severe inflammation. Three of the cases had repeat bronchoscopy done one to four weeks after the initial procedure. All three cases were noted to have significant stenosis of the affected bronchi. CONCLUSIONS: Patients who suffer pill aspiration tend to be elderly and female. The iron group had a greater percentage of cases with severe inflammation even though the mean duration from aspiration to bronchoscopy was similar in the two groups, as was the percentage of cases where residual pill material was found. Currently published cases describing severe long term sequelae of pill aspiration typically had a longer delay between the aspiration event and intervention. CLINICAL IMPLICATIONS: Iron sulfate pill aspiration leads to a quicker and more intense inflammatory reaction compared to other pills. Early bronchoscopy is important as the pill material may be found and removed, thereby avoiding prolonged damage and long term complications. DISCLOSURES: No relevant relationships by Tyler Herzog, source=Web Response No relevant relationships by Harsha Mudrakola, source=Web Response No relevant relationships by Darlene Nelson, source=Web Response