No abstract

Capsule endoscope aspiration into the respiratory tract is a rare complication of capsule endoscopy. Despite the potential seriousness of this complication, no accepted methods exist to accurately predict and therefore prevent it. We describe the case of an 85-year-old male who presented for evaluation of iron deficiency anemia. He complained of dysphagia while ingesting a patency capsule, with several attempts over a period of 5 min before he was successful. Five days later, he underwent capsule endoscopy, where he experienced similar symptoms in swallowing the capsule. The rest of the examination proceeded uneventfully. On reviewing the captured images, the capsule endoscope was revealed to be aspirated, remaining in the respiratory tract for approximately 220 s before images of the esophagus and stomach appeared. To our knowledge, this is the first documented case of a patient who experienced capsule endoscope aspiration after ingestion of a patency capsule. This case suggests that repeated attempts required for ingesting the patency capsule can predict capsule endoscope aspiration. We presume that paying sufficient attention to the symptoms of a patient who ingests a patency capsule could help us prevent serious complications such as aspiration of the capsule endoscope. In addition, this experience implies the potential risk for ingesting the patency capsule. We must be aware that the patency capsule could also be aspirated and there may be more unrecognized aspiration cases.

No abstract

Combination chemotherapy with irinotecan and amrubicin is effective in patients with NSCLC but showed moderate toxicities in second- or third-line settings.

A 42-year-old woman was referred to our hospital for the work-up of iron deficiency anemia. Esophagogastroduodenoscopy (EGD) did not reveal a bleeding source. The appearances on total colonoscopy were normal except for a 20-mm submucosal tumor in the left lateral anal canal (• " Fig. 1). The tumor could be compressed with the endoscope, indicating that it was soft. It was also translucent and lustrous. The tumor and the mucosa surrounding its base were lined with stratified squamous epithelium. Narrow-band imaging (NBI) revealed scattered bullous-like transparent areas on the tumor surface (• " Fig. 2 a). Magnifying endoscopy with narrow-band imaging (ME-NBI) of these areas demonstrated elongated, dark-brown, looping capillary vessels, without dilatation or caliber change, in the superficial layers (• " Fig. 2 b). In addition, small blood vessels were observed in the deeper subepithelial layers (• " Fig. 2 c). The tumor was totally removed using endoscopic submucosal dissection (ESD) and was diagnosed histologically as a lymphangioma (• " Fig. 3). Lymphangiomas of the anal canal are extremely rare. To the best of our knowledge, there are only two previous cases reported, and neither of these included detailed endoscopic findings [1, 2]. Here, we present the notable epithelial and microvascular findings on ME-NBI of an anal lymphangioma for the first time. By comparing the endoscopic and histological findings, we presume that the continuous stretching by distended lymphatic channels resulted in the thinning of the overlying squamous epithelium. This probably caused mucosal transparency and capillary elongation, resulting in the visualization of deeper stromal microvessels. In a case report of esophageal lymphangioma [3], very similar ME-NBI findings were described as being characteristic features. Because the anal canal and esophagus are both covered with stratified squamous epithelium, the ME-NBI diagnostic criteria used for esophageal lymphangioma may also be applicable to anal lymphangioma, as is the case with squamous cell carcinoma [4, 5]. We consider that these unique endoscopic findings might be characteristic of lymphangioma of the anal canal and could be useful in making this diagnosis.