Endoscopic incision of malignant stenosis for the retrieval of a retained capsule endoscope

Capsule endoscopy is one of the least invasive options for enteroscopy, allowing detailed observation of the entire small intestine. However, capsule retention can occur, particularly in patients with small-intestinal stenosis, which may require surgical retrieval in some cases [1]. In cases of capsule retention due to small-intestinal stenosis in Crohn’s disease or other benign lesions, retrieval using balloon enteroscopy has recently been performed. Endoscopic retrieval involving stenosis dilation has also been reported [2] [3] [4]. Here, we report a case of successful endoscopic retrieval of a capsule endoscope retained in a malignant tumor through an incision made using a needle-knife ([Video 1]).

Endoscopic retrieval of a capsule endoscope retained in a malignant tumor through an incision made using a needle-knife.Video 1

A 73-year-old man underwent capsule endoscopy for suspected small-intestinal bleeding. Capsule endoscopy revealed multiple ulcers at the distal end of the ileum, indicating a neoplastic lesion. Abdominal X-ray and computed tomography (CT) scan showed a tumor at the location and the capsule retained in the tumor area due to abnormal thickening of the intestinal wall ([Fig. 1]). Transanal double-balloon small-bowel enteroscopy (EN-580T; Fujifilm Medical, Tokyo, Japan) was performed to remove the capsule, but the capsule was retained at the oral side of the stenosis caused by the malignant tumor. The tumor was diagnosed as malignant lymphoma based on the biopsy specimen. Because the capsule could not pass through the stenosis due to the tumor protruding into the lumen, the tumor was incised using a needle-knife ([Fig. 2]), allowing the capsule to be successfully pulled out through the incised tumor ([Fig. 3]). The incision was accompanied with slight hemorrhage, but no other complications occurred. Endoscopic incision using balloon enteroscopy can be used to remove a retained capsule endoscope due to a small bowel malignant tumor.

Fig. 1 Retained capsule endoscope. a Abdominal X-ray showing a retained capsule endoscope in the right lower part of the abdomen. b Abdominal computed tomography (CT) showing a large malignant tumor located adjacent to the retained capsule. c Enteroscopy showing luminal stenosis and the retained capsule located beyond the stenosis.

Fig. 2 Illustration of capsule retrieval through the endoscopic incision. a The protruded tumor was incised using a needle-knife. b The retained capsule was successfully retrieved.

Fig. 3 Endoscopic incision of malignant stenosis. a Retained capsule is visible at the oral side of the malignant stenosis. b The malignant stenosis was incised with a needle-knife. c The capsule was successfully removed endoscopically.

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Pennazio M, Rondonotti E, Despott EJ. et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022. Endoscopy 2023; 55: 58-95
• 2 Makipour K, Midiri AN, Ehrlich A. et al. Double balloon enteroscopy: effective and minimally invasive method for removal of retained video capsules. Dig Endosc 2014; 26: 646-649
• 3 Gao Y, Xin L, Wang YX. et al. Double-balloon enteroscopy for retrieving retained small-bowel video capsule endoscopes: a systematic review. Scand J Gastroenterol 2020; 55: 105-113
• 4 Van Weyenberg SJB, Van Turenhout ST, Boouma G. et al. Double-balloon endoscopy as the primary method for small-bowel video capsule endoscope retrieval. Gastrointest Endosc 2010; 71: 535-541

Publication History

Article published online:
07 February 2024