INTRODUCTION
Capsule Endoscopy is miniaturized camera within a pill that is swallowed
and takes video of the GI tract as it descends within the digestive tract.
It transmits images wirelessly at a rate of two frames per second to a
portable computer worn on the patients belt. The study duration is appproximately
8 hours. The anatomy of interest is primarily the 20 or so feet of small
bowel that can’t be reached by either an endoscope or colonoscope.
REASONS
FOR EXAM
Indications
for the exam include the following:
·
Obscure gastrointestinal blood loss
· Abnormal imaging of the gastrointestinal tract
· Chronic abdominal pain with reasonable suspicion of organic cause
in the small intestine
· Chronic diarrhea
· Evaluation of Crohn’s disease
· Surveilence of polyposis syndromes
PREPARATION
It is important
not to eat or drink anything for at least six - eight hours before the
exam. Anticoagulant therapy need not be discontinued.
THE PROCEDURE
Capsule endoscopy
is usually performed first thing in the morning after an all night fast.
Upon arriving to the office the morning of the capsule endoscopy study,
the medical assistant will obtain an informed consent for the procedure.
Next a sensory array (‘sticky patches’) is applied to the
abdominal wall of the patient. The recorder device and battery pack is
attached to a waist belt worn by the patient for the duration of the study.
The capsule is then swallowed with water by the patient. The patient is
given last minute instructions and then sent home. The patient can drink
clear liquids after 2 hours; food and medications are permitted 4 hours
after ingestion of the capsule. Later the same day, usually around 4:30
PM, the patient will be instructed to return to remove the recorder device
so the video can be downloaded into the computer. The capsule should be
spontaneously passed in the feces within 48 hours.
RESULTS
The video
will be reviewed by the physician on a computer and a paper report generated,
then sent to the referring physican. The patient will receive the results
either over the phone or at a scheduled follow-up appointment.
BENEFITS
Detailed
videoscopic examination of the small bowel heretofore not possible. Sources
of bleeding and anemia within the small bowel can be discovered, and although
cannot yet be directly treated with the capsule, may lead to definitive
medical or surgical treatment.
ALTERNATIVE TESTING
Alternative
tests to Capsule Endoscopy include barium studies of the intestine. These
tests are very insensitive for small bowel pathology..
RISKS
OF PROCEDURE
Possible
complications exist for any procedure. Capsule retention is the major
concern and occurs with a frequency of 5%. Of these, < 1% require surgical
retrieval. A second problem is delayed passage of the capsule resulting
in termination of the recording before the capsule completes its journey
through the small bowel.
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