Florida Atlantic University Delray Beach, FL, United States
Award: Presidential Poster Award
Polina Gaisinskaya, MD, Yonatan Ghiwot, MD, Alexandra Gonzalez Velez, MD Florida Atlantic University, Delray Beach, FL
Introduction: Capsule endoscopy (CE) is a frequent imaging modality used by gastroenterologists when conventional endoscopy is unable or inconclusive to visualize all necessary portions of the gastrointestinal tract. Some possible complications of CE include capsule retention or aspiration, but they occur in less than 2% of examinations. We present an elderly gentleman who underwent a CE and subsequently aspirated it without significant symptoms.
Case Description/Methods: A 92 year old male with a past medical history of myelodysplastic syndrome, chronic kidney disease and iron deficiency anemia presented to the hospital with blurred vision and slurred speech for 2 days. The patient was initially admitted for a transient ischemic attack work up, which was unremarkable. Gastroenterology was consulted for evaluation of positive fecal occult blood tests and acute on chronic anemia. Of note, on outpatient routine blood work his hemoglobin was 9.3 the week prior, and was found to be 7.9 at presentation. Upper endoscopy and colonoscopy were unrevealing, requiring a CE. During administration of the capsule, the patient felt as if he wasn’t able to swallow the capsule easily but felt it went down after drinking water. He remained without any respiratory symptoms and maintained an oxygen saturation above 94% in room air. The live viewer demonstrated the capsule in the airway the next day. Subsequent chest x-ray confirmed the capsule in the airway. Patient underwent a bronchoscopy for successful retrieval and was discharged following hemoglobin stabilization.
Discussion: Swallowing difficulty is one of the contraindications for CE. In patients without known history of dysphagia but deemed at high risk for aspiration events such as those with history of cerebrovascular events and advanced age, swallow evaluation prior to CE, if feasible, may decrease the risk of aspiration. Gold standard for diagnosis of aspiration and dysphagia is videofluoroscopy (VFS). In the acute setting this may further delay evaluation. In a double-blind observational study the combination of bedside swallow and monitoring of oxygen saturation compared to VFS in patients with acute stroke was used. This combination showed an increase in the positive predictive value for diagnosis of aspiration. This may be a cost effective and time saving alternative that will help mitigate the risk of CE aspiration and prevent delay of evaluation. If there is uncertainty regarding swallowing ability, post pyloric placement of the capsule should be considered.
Figure: The live viewer demonstrated the capsule in the airway which prompted the chest x-ray revealing the aspirated capsule.
Polina Gaisinskaya indicated no relevant financial relationships.
Yonatan Ghiwot indicated no relevant financial relationships.
Alexandra Gonzalez Velez indicated no relevant financial relationships.
Polina Gaisinskaya, MD, Yonatan Ghiwot, MD, Alexandra Gonzalez Velez, MD. P1497 - Necessity of Swallow Evaluations in the Elderly Prior to Capsule Endoscopy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.