A Two-Step Strategy Utilising Fluoroscopy for Resolving Peripheral Airway Impaction by an Aspirated Capsule Endoscope: A Case Report.

Capsule endoscopy (CE) aspiration is extremely rare (0.003%-0.013%) but potentially life-threatening. The CE is structurally challenging for standard bronchoscopic removal due to its large size, smooth surface and nonmetallic composition. While most aspirated capsules remain in the central airways, reports on peripheral impaction are limited. We report a case in which a CE was impacted deep within the right basal segmental bronchus of a man in his 70s. Conventional forceps manipulation failed because the capsule was completely impacted, preventing visibility beyond the obstruction. We successfully employed a two-step strategy: (1) disimpaction using a balloon catheter guided by fluoroscopy and (2) retrieval in the central airway using a retrieval loop net. This fluoroscopy-assisted two-step strategy provides a safe and reliable approach for retrieving structurally challenging foreign bodies in the peripheral airways.