Case study
Endoscopic capsule endoscope delivery for patients with dysphagia, anatomical abnormalities, or gastroparesis☆

https://doi.org/10.1016/S0016-5107(03)02683-XGet rights and content

Abstract

Background

Capsule endoscopy relies on an intact swallowing mechanism and unimpeded passage of the capsule through the pylorus. A technique is described for endoscopic delivery of the capsule in patients with dysphagia, anatomical abnormality, or gastroparesis.

Methods

EGD is performed with concomitant placement of an overtube. A foreign body net retrieval device is passed through the endoscope and used to grasp the activated capsule in the net. The endoscope then is advanced through the overtube, and the capsule is released in the duodenum.

Observations

Five patients underwent endoscopic placement of the capsule. Relative contraindications to peroral ingestion were the following: oropharyngeal dysphagia, pyloric stenosis (2), prior gastric surgery, and gastroparesis. Endoscopic delivery was successful in all cases and yielded positive findings in 4. There was no complication.

Conclusions

Endoscopic delivery of the capsule endoscope for patients with dysphagia, anatomical abnormality, or gastroparesis is safe and effective.

Section snippets

Study methods

All patients were studied who underwent CE between August 2001 and June 2003, and in whom dysphagia, anatomical abnormality, or gastroparesis prevented normal passage of the capsule.

Case 1

An 85-year-old man was referred because of an 8-month history of GI bleeding of obscure etiology. Four separate episodes of hematochezia had resulted in hospitalization with transfusion of 4 units of packed red blood cells on each occasion. He had oropharyngeal dysphagia from a prior stroke and received all

Observations

A total of 329 CE studies were performed between August 21, 2001, and June 17, 2003. In 324 cases, the capsule was ingested orally. In a single case, the capsule became impacted at the cricopharyngeus and required endoscopic retrieval.3 In 5 patients (1.5%), the capsule was delivered successfully into the duodenum (1.5% of CE studies) by using the technique described. The use of APC, a form of electrosurgery, in case 2 did not affect the capsule images.

Mucosal abnormalities that were likely the

Discussion

GI obstruction and pseudo-obstruction are absolute contraindications to CE.4 Relative contraindications include dysphagia, gastroparesis, known or suspected GI stricture, pregnancy, motility disorders, and Zenker's diverticulum. The technique described here is safe and effective for endoscopic delivery of the capsule to the duodenum in patients with relative contraindications to CE. Relative contraindications in the present series of patients included oropharyngeal dysphagia, pyloric stenosis

Cited by (0)

☆

This material was presented in part at the American Society for Gastrointestinal Endoscopy Video Forum, May 19, 2003, Digestive Diseases Week, Orlando, Florida.

View full text
Copyright © 2004 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.