Capsule Aspiration During Capsule Endoscopy: A Clinical Review for Patient Safety

Purpose: Capsule aspiration is a rare but potentially serious complication of capsule endoscopy. This review aimed to analyze reported cases of capsule aspiration and identify implications for patient safety.Methods: A literature review was conducted using MEDLINE, Embase, CINAHL, KoreaMed, ScienceON, and relevant journals. Case reports and series describing capsule aspiration during capsule endoscopy were included. Data on patient characteristics, clinical presentation, diagnosis, management, and outcomes were extracted and analyzed descriptively.Results: Thirty cases of capsule aspiration were identified. The mean age was 77.1 years, and 96.7% of cases occurred in older adults, predominantly men. Dysphagia was reported in six cases, while information regarding swallowing status was frequently lacking. Cough was the most common symptom; however, 20.0% of patients were asymptomatic, suggesting the possibility of silent aspiration. Most aspirations were recognized immediately after capsule ingestion, and the capsule was most commonly located in the right bronchial tree. Real-time monitoring was used in only 30.0% of cases. Bronchoscopy was performed in nearly all non-spontaneously resolved cases, and all aspirated capsules were successfully retrieved. Pneumonia and atelectasis were reported in two cases.Conclusion: Capsule aspiration occurs predominantly in older adults and may be underrecognized because symptoms are often mild or absent. Careful preprocedural assessment of swallowing function, increased awareness of aspiration risk, and early post-ingestion monitoring may improve patient safety. Additional preventive recommendations for high-risk patients should be incorporated into future clinical guidelines.