Kaitlyn M. Egger, DO1, Chung Sang Tse, MD2, Abbas Rupawala, MD3 1Brown University, Warwick, RI; 2University of California, San Diego, San Diego, CA; 3Warren Alpert Medical School of Brown University, Providence, RI
Introduction: Capsule endoscopy is a safe and effective way to evaluate the small intestine. When capsules are swallowed, video capsule aspiration is a rare but life-threatening complication occurring in an estimated 1/1,000 cases. This case and supporting video depict a capsule retained in the pharynx (clearly visible vocal cords), and the endoscopic techniques utilized to successfully relocate the capsule into the stomach.
Case Description/Methods: A 69 year-old male with a history of metastatic small cell lung cancer and deep vein thrombosis on apixaban presented with melena and acute anemia requiring blood transfusion. Apixaban was held and he underwent emergent EGD and colonoscopy which showed no active bleeding. After a normal speech evaluation with a modified barium swallow study the patient underwent capsule endoscopy. Within minutes of swallowing a video capsule, the patient reported a globus sensation. He attempted to swallow, cough and drink water, with no relief in the absence of respiratory distress and without foreign bodies visualized in the oral cavity or posterior pharynx. Live transmission of the capsule images allowed the epiglottis, vocal cords, aryepiglottic fold and cartilage to be seen.
Urgent EGD was performed with moderate sedation (while awaiting for anesthesia and ENT). The capsule was retained in the pharynx bouncing between the left and right pyriform fossa, anterior to the epiglottis and superior to the vocal folds. Two unsuccessful attempts were made to capture the capsule using: Magill forceps (unable to grasp the capsule) and latex hood (inverted onto the scope within the oral cavity). The third attempt with a distal attachment cap, was successful at capturing the capsule and advancing it safely through the esophagus and into the stomach. On review of the video capsule, the capsule first entered the stomach 72 minutes after swallowing and thereafter traversed the remainder of the GI tract without difficulty.
Discussion: This case illustrates that despite normal upper endoscopy and swallow study, video capsule aspiration remains a potentially life-threatening risk. Prior case reports of bronchial aspiration of capsules have been managed with urgent bronchoscopy. In our case, after the patient developed a globus sensation, the live transmission of capsule images located the capsule in the pharynx, prompting urgent endoscopic intervention. The distal attachment cap was safe and effective in capturing the retained capsule and relocating it in the stomach.
Kaitlyn Egger indicated no relevant financial relationships.
Chung Sang Tse indicated no relevant financial relationships.
Abbas Rupawala: Medtronic – Consultant.
Kaitlyn M. Egger, DO1, Chung Sang Tse, MD2, Abbas Rupawala, MD3. P2792 - Successful Endoscopic Management of a Video Capsule Retained in the Pharynx, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.