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Tuesday, November 17, 2015

CAPSULE ENDOSCOPY

Understanding Capsule Endoscopy

What is Capsule Endoscopy?

Capsule Endoscopy lets your doctor examine the lining of the middle part of your gastrointestinal tract, which includes the three portions of the small intestine (duodenum, jejunum, ileum). Your doctor will give you a pill sized video camera for you to swallow. This camera has its own light source and takes pictures of your small intestine as it passes through. These pictures are sent to a small recording device you have to wear on your body. 
Your doctor will be able to view these pictures at a later time and might be able to provide you with useful information regarding your small intestine.Capsule Endoscopy image
Why is Capsule Endoscopy Done?

Capsule endoscopy helps your doctor evaluate the small intestine. This part of the bowel cannot be reached by traditional upper endoscopy or by colonoscopy. The most common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine. It may also be useful for detecting polyps, inflammatory bowel disease (Crohn’s disease), ulcers, and tumors of the small intestine.

As is the case with most new diagnostic procedures, not all insurance companies are currently reimbursing for this procedure. You may need to check with your own insurance company to ensure that this is a covered benefit.
How Should I Prepare for the Procedure?

An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink, including water, for approximately twelve hours before the examination. Your doctor will tell you when to start fasting.

Tell your doctor in advance about any medications you take including iron, aspirin, bismuth subsalicylate products and other over-the-counter medications. You might need to adjust your usual dose prior to the examination.

Discuss any allergies to medications as well as medical conditions, such as swallowing disorders and heart or lung disease.

Tell your doctor of the presence of a pacemaker or defibrillator, previous abdominal surgery, or previous history of bowel obstructions in the bowel, inflammatory bowel disease, or adhesions.
Your doctor may ask you to do a bowel prep/cleansing prior to the examination.
What Can I Expect During Capsule Endoscopy?

Your doctor will prepare you for the examination by applying a sensor device to your abdomen with adhesive sleeves (similar to tape). The pill-sized capsule endoscope is swallowed and passes naturally through your digestive tract while transmitting video images to a data recorder worn on your belt for approximately eight hours. At the end of the procedure you will return to the office and the data recorder is removed so that images of your small bowel can be put on a computer screen for physician review.
Most patients consider the test comfortable. The capsule endoscope is about the size of a large pill. After ingesting the capsule and until it is excreted you should not be near an MRI device or schedule an MRI examination.
What Happens After Capsule Endoscopy?

You will be able to drink clear liquids after two hours and eat a light meal after four hours following the capsule ingestion, unless your doctor instructs you otherwise. You will have to avoid vigorous physical activity such as running or jumping during the study. Your doctor generally can tell you the test results within the week following the procedure; however, the results of some tests might take longer.
What are the Possible Complications of Capsule Endoscopy?

Although complications can occur, they are rare when doctors who are specially trained and experienced in this procedure perform the test. There is potential for the capsule to be stuck at a narrowed spot in the digestive tract resulting in bowel obstruction. This usually relates to a stricture (narrowing) of the digestive tract from inflammation, prior surgery, or tumor. It’s important to recognize obstruction early. Signs of obstruction include unusual bloating, abdominal pain, nausea or vomiting. You should call your doctor immediately for any such concerns. Also, if you develop a fever after the test, have trouble swallowing or experience chest pain, tell your doctor immediately. Be careful not to prematurely disconnect the system as this may result in loss of pictures being sent to your recording device.
Capsule endoscopy may also be called:
  • capsule enteroscopy
  • wireless capsule endoscopy
Capsule endoscopy allows for examination of the small intestine, which cannot be easily reached by traditional methods of endoscopy.

What type of diseases can be diagnosed with capsule endoscopy?

Capsule endoscopy continues to improve technically. It has revolutionized diagnosis by providing a sensitive (able to identify subtle abnormalities) and simple (non-invasive) means of examining the inside of the small intestine. Some common examples of small intestine diseases diagnosed by capsule endoscopy include:
  1. Angiodysplasias (collections of small blood vessels located just beneath the inner intestinal lining that can bleed intermittently and cause anemia)
  2. Small intestinal tumors such as lymphoma, carcinoid tumor, and small intestinal cancer
  3. Crohn's disease of the small intestine 

What are the limitations of capsule endoscopy?

While the capsule provides the best means of viewing the inside of the small intestine, there are many inherent limitations and problems with its use, the most important of which is thatthe capsuledoes not allow for therapy. Other problems include:
  1. Abnormalities in some areas of the intestine are missed because of rapid transit of the capsule and blurred, uninterpretable photographs. The images can also be blurred by retained stool of food debris. Hence the importance of a good bowel preparation prior to the capsule endoscopy.
  2. At times, transit is so slow that the capsule examines only part of the small intestine before the battery fails. The battery life is about eight hours.
  3. If abnormalities are discovered that require surgical resection or further investigation, it may be difficult to determine where in the small intestine the abnormality is and thereby help direct therapy.
  4. If there are narrow areas due to scarring (strictures) or tumors in the small intestine, the capsule can get stuck in the narrow area and cause an obstruction of the intestine that requires surgical removal of the capsule. (For this reason, in patients who are suspected of having a stricture, a self-dissolving, dummy capsule is swallowed first. If the dummy capsule sticks, it can be seen on an x-ray of the abdomen and the location of the stricture determined. Because it dissolves with time, however, the obstruction will resolve without surgery, and the real capsule will not be swallowed.)
  5. Finally, reviewing the tens of thousands of photographs is very time consuming for the conscientious physician. 
IMPORTANT REMINDER:
This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.