Aspiration Of Capsule Endoscope Research Articles

CAPSULE BRONCHOSCOPY: A PILL ENDOSCOPY GONE WRONG

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

Aspiration of capsule endoscope

Aspiration of capsule endoscope

Gastrointestinal: Symptomatic bronchial aspiration of capsule endoscope – a significant complication

Gastrointestinal: Symptomatic bronchial aspiration of capsule endoscope – a significant complication

Aspiration of Capsule Endoscope and Successful Bronchoscopic Extraction

Capsule endoscopy is a novel tool for the diagnosis of small intestinal disorders. Recently, a new complication of the procedure in the form of the capsule's aspiration into the lungs has been reported. The aspiration of capsule endoscope can lead to a variety of complications including respiratory failure. A low threshold to suspect this complication and urgent bronchoscopic extraction in appropriate patients can prevent serious sequelae.

Tracheal Aspiration of Capsule Endoscopes: Completing a Cases Compilation

We read with great interest the report and compilation of cases of capsule endoscope (CE) aspiration by Lucendo et al. [1]. We would like to add two more cases to complete the compilation of reported cases. We had described the case of a 76-year-old man who underwent an inpatient CE with PillCam" SB1 and experienced a short-lived (15 s), by and large asymptomatic aspiration [2]. Depriest et al. [3] reported the case of a 90-year-old man, with multiple comorbidities, who aspirated the CE into the left main bronchus and eventually underwent flexible bronchoscopy for retrieval of the device with a Roth net. As in the Lucendo et al. case, CE aspiration in the aforementioned cases precipitated the cough reflex, which (albeit weak) in our case, led to dislodgment of the capsule and uneventful completion of the test. Lucendo et al. [1] point out that in case of CE aspiration, the relative size of the CE (11 9 26 mm) compared with the average antero-posterior and transverse diameter of an adult trachea (16 and 14 mm, respectively), allows enough space for adequate patient oxygenation; therefore, no fatalities have been described until now. Although four companies are competing in the market for the production of capsule endoscopy systems, the PillCam"SB remains the most widely used capsule worldwide for the study of the small bowel [4]. The sum total of CE aspirations reports are with PillCam"SB; interestingly, EndoCapsule" (Olympus Medical Systems, Tokyo Japan) is of exactly the same dimensions, while Intromedic Co. Ltd., Seoul, Korea produces the smaller and lighter MiroCam" (11 9 24 mm, 3.4 g), while Jinshan Science and Technology Company, Chongqing, China provides the bigger and heavier OMOM"CE. It is tempting to hypothesize that, although the possibility of a rare complication is more likely with the more commonly used system, the CE size might play a role in the response. Since a number of CE aspiration cases present with no or very weak cough (as in our case), we believe that patients with increased aspiration risk should swallow the CE while connected with real-time viewers, available for each system at the point of capsule ingestion. However, despite the theoretical advantage of a smaller and lighter shape, the image transmission mode of the Mirocam"CE does not generally allow acquisition of useful images of the oropharynx/upper esophagus during the ingestion phase. Finally, we would like once more to note that a potential serious complication as this should be included in the consent form for the procedure [2] and that for certain patient cohorts (elderly, patients with dysphagia or multiple co-morbidities) CE administration should take place in a controlled environment with oxygen and resuscitation facilities at close proximity. In our practice, we always confirm CE position with a real-time viewer in the immediate post-ingestion period, and prior to allowing patient discharge. Moreover, if endoscopy capsule placement is considered necessary we prefer to use for this the AdvanCE" delivery device and not the Roth net as we found that the floppiness of the last and its pointy end prevent a comfortable esophageal intubation. A. Koulaouzidis (&) ! S. Douglas ! J. N. Plevris Endoscopy Unit, Centre for Liver & Digestive Diseases, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK e-mail: akoulaouzidis@hotmail.com