A systematic review of capsule aspiration in capsule endoscopy.

Background

Capsule endoscopy (CE) is safe and widely accepted for small bowel (SB) investigation and an alternative to colonoscopy in specific clinical circumstances. As the capsule is orally ingested, the potential risk of aspiration is undoubtedly a constant concern among clinicians. However, it is a rare occurrence and often reported as isolated cases. Therefore, this review systematically compiles all the available data on capsule aspiration in the literature with an aim to provide an update on this complication of CE.

Methods

A systematic literature search was performed on PubMed with the search terms 'capsule endoscopy' AND 'aspiration', searched as keywords and MeSH. All observational cohort studies that reported aspiration among complications/outcomes, case reports and series on capsule aspiration were included. Manual citation search was performed. Two extractors reviewed abstract and full-text and performed data extraction.

Results

We found 95 relevant articles, and cross-checking references led to the inclusion of an additional 19 articles. We removed 57 and ended with 57 references-with 63 cases of aspirated capsules. One death was reported. The median age was 78, and there was male preponderance. The most common indication for CE was anaemia, and only aspiration of small bowel CE (SBCE) was reported. 61.9% of the aspirations were symptomatic; the most common symptom was coughing. 69.8% of capsules ended in the bronchus, but only 4 cases experienced desaturation. Thirty-two patients needed intervention for retrieval; the aspiration was self-resolved in the remaining. Only four patients had a history of dysphagia. Thirteen instances of aspiration were detected due to real-time viewing, and 24 cases from reviewing the capsule data afterwards.

Conclusions

With only 63 cases of aspirated capsules reported in the literature, this event remains rare, is safely managed, and should not discourage patients from the procedure. The importance of careful patient selection is crucial to minimize the likelihood of aspiration and capsule administration should be approached with precautions.

Informations de copyright

2024 Annals of Translational Medicine. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-23-763/coif). A.K. serves as an unpaid editorial board member of Annals of Translational Medicine from October 2022 to September 2024. A.K. reports that he is a co-director and shareholder of AJM Medicaps, and iCERV Ltd.; and receiving consultancy fees (Jinshan Ltd. And DiagMed Healthcare Ltd.), travel support (Jinshan, DiagMed Healthcare Ltd.), research support (grant) from ESGE/Given Imaging Ltd. and (material) IntroMedic/SynMed, lecture honoraria (Jinshan, Medtronic). He participated in Advisory board meetings for Tillots, ANKON, Dr Falk Pharma UK. The other authors have no conflicts of interest to declare.