Endoscopic administration of capsular therapeutic iodine-131 in patients unable to swallow: A novel technique

Objectives Oral administration of iodine-131 (I-131) in patients with swallowing difficulties can be challenging. Historically, these patients have been given liquid I-131 administered via nasogastric or percutaneous gastrostomy tube. This technique presents a number of difficulties, including uncertainty of dosing related to iodine adherence to tubing; risk of inadvertent delivery of dose into the incorrect lumen of a multilumen tube; risk of spillage; and risk of exposure to personnel. Insofar as there are no existing standards or procedures for administration of I-131 to patients with swallowing difficulties, our institution has created a protocol for addressing this patient population.

Methods Our technique involves administering I-131 in a capsule which is placed endoscopically directly into the patient’s stomach. This allows for certainty of dosing, elimination of risk of incorrect administration, elimination of risk of spillage, and decreased risk of exposure to attendant personnel. Unintended exposure to the patient’s non-target organs, such as the esophagus, is also minimized.

Results In the non-swallowing patient for whom this technique was developed, the I-131 capsule was successfully deposited into the patient's stomach. Time elapsed for removing the capsule from shielding, snaring in the endoscopic net, and depositing into the stomach was approximately one minute.

Conclusions Endoscopic delivery of capsular I-131 should be considered for any patient with swallowing difficulties requiring I-131 therapy