Small-bowel capsule endoscopy: A ten-point contemporary review

Table 6 Case reports of aspiration of capsule endoscopes

Ref.	Case (age/gender)	Comorbidities	CE model/company	Swallowing difficulties	No. of attempts to swallow CE/gagging or coughing	Aspiration time/where in bronchial tree CE seen	Capsule removal (if employed)	Final diagnosis
Schneider et al[72]	64/male	Mechanical MV on phenprocoumon, BMI 15.5	M2A®; Given®Imaging Ltd.	No Hx of dysphagia	4/gagging and spitting capsule - last attempt recurrent coughing (aspiration presumed)	2 min/trachea-bronchi	Spontaneous resolution	NS
Fleischer et al[73]	76/male	HHT	M2A®; Given®Imaging Ltd.	No Hx of dysphagia	1/lodged in his throat - no respiratory difficulty, could talk, vital signs normal	60 min/cricopharyngeus	Endoscopy-Roth net; 6 d post-dilation, patient ingested capsule with no problem	Spasticity, prominence of cricopharyngeus; endoscopy and oesophageal dilation 1 wk later
Sinn et al[74]	69/female	On phenprocoumon	M2A®; Given®Imaging Ltd.	No Hx of dysphagia	1/coughed several times	50 s/bifurcation of the trachea	Spontaneous resolution	NS
Tabib et al[75]	87/female	Recent onset IDA, CHF, IHD, AF, bladder cancer, CRF	M2A®; Given®Imaging Ltd.	No Hx of dysphagia, pre-CE barium meal	2/choking, dyspnoea, CE felt lodged in the throat	NS/right main-stem bronchus - bronchus intermedius	Rigid bronchoscopy	NS
Buchkremer et al[76]	74/male	Recent diagnosis of coeliac disease; past Hx of ankylosing spondylitis	M2A®; Given®Imaging Ltd.	No Hx of dysphagia	NS/dyspnoea started after CE ingestion	NS/right main-stem bronchus	Flexible bronchoscopy	NS
Rondonotti et al[77]	NS	NS	M2A®; Given®Imaging Ltd.	NS	NS/coughed several times	NS/NS	Spontaneous resolution	NS
Nathan et al[78]	93/male	No significant past medical Hx	M2A®; Given®Imaging Ltd.	No Hx of dysphagia	1/coughed hours post-ingestion	Approximately 8 h/bronchial tree	Spontaneous resolution	NS
Shiff et al[79]	75/male	NS	M2A®; Given®Imaging Ltd.	No Hx of dysphagia	2/some coughing	NS/bronchi	Spontaneous resolution	NS
							Eventually, CE endoscopic placement
Sepehr et al[80]	67/male	HTN, DM, CVA	NS	Hx of dysphagia (intermittent)	1/coughing, tachypnoea, and tachycardia	NS/trachea	Endoscopy-Roth net	NS
Koulaouzidis et al[81]	76/male	NS	PillCam®SB; Given®Imaging Ltd.	No Hx of dysphagia	1/coughed weakly	15 s/trachea	Spontaneous resolution	NS
Guy et al[82]	90/male	Ischaemic CVA	NS	No Hx of dysphagia	NS/no symptoms	NS/bronchial tree	Rigid bronchoscopy - stone retrieval basket	NS
Leeds et al[83]	85/male	NS	NS	No Hx of dysphagia	NS/difficulty swallowing CE, slightly painful	8 h/lobar bronchus	Spontaneous resolution	NS
Bredenoord et al[84]	65/male	Sigmoid colectomy for diverticulae; Ileal carcinoid resected	NS	Hx of dysphagia	Lengthy swallowing attempt/coughing noted	NS/right main bronchus	Spontaneous resolution, eventually, CE was swallowed on same session	Normal small-bowel
Choi et al[85]	75/male	Prior CVA	PillCam®SB; Given®Imaging Ltd.	No Hx of dysphagia	NS/coughed several times	2 h/left main bronchus	Flexible Bronchoscopy-Roth net and bronchial wall irrigation to induce cough	NS, patient declined further investigations
Depriest et al[86]	90/male	IHD, AF, PVD (warfarin + clopidogrel)	PillCam®SB; Given®Imaging Ltd.	No Hx of dysphagia	NS/some cough	NS/left main bronchus, then right main bronchus	Chest percussive therapy + postural drainage; Flexible bronchoscopy + extraction basket + Roth net	NS
Depriest et al[86]	90/male	IHD, AF, PVD (warfarin + clopidogrel)	PillCam®SB; Given®Imaging Ltd.	No Hx of dysphagia	NS/some cough	NS/left main bronchus, then right main bronchus	Chest percussive therapy + postural drainage; flexible bronchoscopy + extraction basket + Roth net	NS
Kurtz et al[87]	73/male	Renal cell cancer, MV (bovine), hyperlipidaemia, melaena	NS	No Hx of dysphagia	Sips of water, 1st attempt, 2 min later non-productive cough (20 s)	Level of carina; then right main stem bronchus	Bronchoscopy-retrieval basket (multiple spontaneous ejections from trachea prior bronchoscopy)	NS
Lucendo et al[88]	80/male	Advanced PD, DM, walking + speech difficulties	PillCam®SB; Given®Imaging Ltd.	No Hx of dysphagia	Several attempts/persistent coughing and some dyspnoea	20 s/tracheobronchial tree	Spontaneous resolution	Oesophageal ulcer + ileal ulcer
Pezzoli et al[89]	82/male	Unexplained anemia, HTN	NS	No Hx of dysphagia	NS/asymptomatic (minimal cough)	3 d/in the right bronchus	Spontaneous resolution	NS
Parker et al[90]	77/female	Hysterectomy	NS	No Hx of dysphagia	Initial attempt unsuccessful/chocking episode, CE coughed-up	NS/NS	Spontaneous resolution, endoscopic placement with AdvanCE® device	Patient suffered intracranial bleed, eventually succumbed
Despott et al[91]	65/male	COPD, cirrhosis, pancreatitis	NS	No Hx of dysphagia	NS/asymptomatic	NS/right main bronchus	Rigid bronchoscopy-Roth net	Endoscopic placement with AdvanCE® device
	73/male	COPD	NS	NS	NS/brief coughing	NS/left main bronchus	Bronchoscopy-snare + Roth net	Endoscopic placement with AdvanCE® device
	81/male	NS	NS	NS	NS/fleeting choking sensation	NS/right main bronchus	Rigid bronchoscopy-crocodile grasping forceps	NS
Girdhar et al[92]	83/male	COPD, GORD	PillCam®SB; Given®Imaging Ltd.	No Hx of dysphagia	Difficult, requiring multiple sips of water/some cough, after 1 h mild shortness of breath	NS/left main bronchus	Flexible bronchoscopy + rat-tooth alligator forceps + stiff-wire basket with a pin-vise handle	NS
Poudel et al[93]	80/male	AF, IHD, CVA on anti-coagulants, anaemia + melaena	M2A®; Given®Imaging Ltd.	NS	NS	24 h/left main stem bronchus; then right bronchus	Flexible bronchoscopy + net + snare forceps + tripod; eventually, grasped with basket	NS

MV: Mitral valve; BMI: Body mass index; HHT: Hereditary haemorrhagic telangiectasia; IDA: Iron deficiency anaemia; CHF: Chronic heart failure; IHD: Ischaemic heart disease; AF: Atrial fibrillation; CRF: Chronic renal failure; Hx: History; Ns: Not stated; HTN: Hypertension; DM: Diabetes mellitus; CVA: Cerebrovascular accident; PVD: Peripheral vascular disease; PD: Parkinson’s disease; COPD: Chronic obstructive pulmonary disease; GORD: Gastro-oesophageal reflux disease; CE: Capsule endoscopy.