A 71-year-old man was admitted for capsule endoscopy because of
overt gastrointestinal bleeding. Previous gastroscopy and colonoscopy were
normal.
Capsule endoscopy was performed with an M2A capsule (Given Imaging
Ltd., Yoqneam, Israel). The recorded video showed undigested food; however, no
small bowel mucosa was visible, therefore capsule retention in the esophagus
was suspected. Contrast swallow was performed, which showed the capsule in a
9-cm Zenker’s diverticulum ([Fig. 1]),
unknown until that point. When interviewed, the patient said he had not
experienced any symptoms of esophageal disease, such as dysphagia or
regurgitation of food.
Fig. 1 Contrast swallow,
showing the capsule in a Zenker’s diverticulum.
Due to the size of the diverticulum, spontaneous expulsion of the
capsule was improbable, so we decided to remove it. At gastroscopy, the
endoscope easily entered the esophagus. Careful examination was needed to find
the entrance to the diverticulum. Inside the diverticulum, the capsule was
found ([Fig. 2]) and extracted using a Roth net. A
new capsule was delivered to the duodenum endoscopically.
Fig. 2 Endoscopic image of the
capsule inside the diverticulum.
Retention of the capsule is a rare complication in capsule endoscopy
(reported in 1 – 2 % of capsule endoscopies).
The risk of capsule retention is higher in Crohn’s disease or suspected
stenosis of the small bowel (5 – 21 % of
patients) [1]
[2]. There are case
reports of capsule retention in diverticula of the small bowel
[3]. Capsule retention in an esophageal diverticulum is
very rare during capsule endoscopy, and there are only a few case reports of
capsule retention in a Zenker’s diverticulum [4]
[5]. In all reported cases, endoscopic removal was
possible.
We suggest that, in patients with known esophageal diverticula,
primary endoscopic placement of the video capsule should be performed.
Endoscopy_UCTN_Code_TTT_1AP_2AB
