Capsule Endoscopy

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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