Video Capsule Endoscopy - Think Pharyngeal Pouch - Retention of a Video Capsule in a 94-Year-Old in the Upper Gastrointestinal Tract - Case Report

Sep 29, 2026

Video capsule endoscopy (VCE) provides non-invasive endoluminal visualization of the small bowel and is generally safe, with capsule retention the main rare complication. Upper gastrointestinal retention is extremely uncommon. The case involves a 94-year-old patient with capsule lodging in an undiagnosed pharyngeal pouch after an acute admission for gastrointestinal bleeding. The capsule migrated within 24 hours with conservative management, and the report highlights the need to consider prior history or pharyngeal pouch before VCE.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Introduction

Video capsule endoscopy and indications

Definition and risk of capsule retention

Upper GI retention rarity

Case Report

Video Capsule Endoscopy: Think Pharyngeal Pouch–Retention of a Video Capsule ina 94-Year-Old in the Upper Gastrointestinal Tract William Tai, Renate Claassen Department of Medicine for the Elderly, Addenbrookes Hospital, Cambridge, UK Corresponding Author: William Tai, MBChB, MRCP(UK) Department of Medicine for the Elderly, Addenbrookes Hospital, Box 135, Cambridge CB2 0QQ, United Kingdom [E-mail: willtai88@googlemail.com](E-mail: willtai88@googlemail.com)[ ](E-mail: willtai88@googlemail.com)ORCID: [https://orcid.org/0009-0000-6951-8279](https://orcid.org/0009-0000-6951-8279) [Received: June 4](Received: June 4), [2025](2025) Revised: August 1, 2025 Accepted: August 15, 2025 Video capsule endoscopy (VCE) provides endoluminal visualisation of the small bowel. It is often regarded as well-tolerated, non-invasive, and safe across all age groups, with the main, albeit rare, complication of retention of the capsule, normally in the small bowel or lower gastrointestinal (GI) tract. Retention in the upper GI tract is extremely rare; here, we present a case of a 94-year-old who experienced capsule retention in a previously undiagnosed pharyngeal pouch. This appears to be the first case report detailing video capsule retention in a pharyngeal pouch involving a patient of such an advanced age, and in which endoscopic retrieval was not necessitated. The learning here is that patients should be evaluated for prior medical history or the possibility of a pharyngeal pouch before performing VCE. Key Words: Geriatrics, Capsule endoscopy, Zenker diverticulum INTRODUCTION Video capsule endoscopy (VCE) is a non-invasive and well-tolerated investigative modality that provides endoluminal imaging of the small bowel.1) Common indications include investigation of unexplained gastrointestinal (GI) bleeding, unexplained iron deficiency anaemia, and evaluation for and monitoring of, Crohn’s disease.2) In the instances ofthe first and second indications, VCE normally follows diagnostically unyielding upper and lower GI tract endoscopies.3) Retention of the video capsule is the main adverse event and generally occurs in the small bowel or lower GI tract, and is defined as failure of the capsule to pass through the GI tract after 2 weeks of ingestion.1) The incidence of this complication is reportedly low, occurring in only 1%–2% of cases; however, this figure can be as high as 4%–13% in patients with inflammatory bowel disease, in which they are more susceptible to stricture formation.4,5) Older age alone is not recognised as a risk factor.4) Retention of the capsule in the upper GI tract is reportedly extremely rare. A 2023 literature review by Arzivian et al.1) noted that there are only a small handful of case reports describing capsule re- tention in the upper GI tract. Within these, all 12 of the described patients were older adults with a median age of 75.8 years. American and Canadian guidelines on VCE contraindications mention swallowing and motility disorders ofthe upper GI tract, but do not specifically reference the presence of a pharyngeal pouch.6,7) We present here a unique case of a 94-year-old patient who hada video capsule become lodgedin her upper GI tract, in anundiagnosed pharyngeal pouch, during an acute hospital admission with a GI bleed. The capsule migrated within 24 hours with conservative management. CASE REPORT A 94-year-old woman with a medical history of osteoporosis and transient ischaemic attack presented to our emergency department from a care home following a syncopal episode while on the commode. Of note, her carers had noted black coloured stools in the commode pan. Her medications included denosumab, aspirin and calcium-vitamin D supplements. On examination in the emergency department, she was alert, and her vital signs included a blood pressure of 102/64 mmHg, © 2025 by The Korean Geriatrics Society This is an open access article distributed under the terms of the Creative Commo

FAQs

What is video capsule endoscopy (VCE) used for?

VCE provides endoluminal imaging of the small bowel. It is commonly used for unexplained GI bleeding, unexplained iron deficiency anaemia, and assessment or monitoring of Crohn’s disease.

How is capsule retention defined and how common is it?

Capsule retention is defined as failure of the capsule to pass through the GI tract after 2 weeks of ingestion. The incidence is reportedly low (about 1%–2%), but can be higher (4%–13%) in inflammatory bowel disease due to susceptibility to stricture formation.

Why did capsule retention occur in this case?

The capsule became lodged in an undiagnosed pharyngeal pouch during an acute hospital admission for GI bleeding. Conservative management led to migration of the capsule within 24 hours.

Sep 29, 2026

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