Capsule Endoscopy

What is Capsule Endoscopy?

The small intestine cannot be seen by conventional upper as well as lower endoscopy. Visualization of the small intestine in such a way so as to see diseases already visible by other means (strictures and
tumors seen on barium studies as well as CT scan) as well as subtle abnormalities such as flat lesions and vascular abnormalities is achieved by Wireless Capsule Endoscopy. Capsule Endoscopy involves ingesting a small Pill Cam® which will pass naturally through your digestive system whilst taking pictures of the intestine. The images are transmitted to the Data Recorder. The Pill Cam® is disposable and will pass naturally. Typically, undiagnosed abdominal pain, unresolved diagnosis in diarrhea, as well as to look for small lesions causing blood loss can be accurately assessed by Capsule Endoscopy.

Briefly, what is the technology in Capsule Endoscopy:

A capsule has a size of 11 x 30 mm; thus is larger than the largest pill. The capsule is easy to swallow, but it will not be possible in known swallowing disorders. The Capsule contains one or two video chips (cameras), a light bulb, a battery, and a UHF band telemetry transmitter. As the capsule travels down, it takes photographs rapidly. The photographs are transmitted by the radio transmitter to a small receiver that is worn on the waist of the patient who is undergoing the capsule endoscopy. At the end of the procedure, approximately 8 hours later, the photographs are downloaded from the receiver into a computer, and the images are reviewed by a physician. The capsule is a single use device and need not be brought back.

What makes Capsule Endoscopy so popular?

The capsule is easy to swallow; the procedure is painless and sedation free & the patient can relax in comfort and walk about; and there is no exposure to potentially harmful radiation. Endoscopes have been made to enter and evaluate the small intestine (Double Balloon Enteroscopes) but this procedure will need deep sedation, may need between 1-2 hours, and have much more risks than Capsule Endoscopy

Can the capsule miss seeing an important finding?

Rapid transit of the capsule may give blurred photographs. Stool or food debris may hide a finding; hence the importance of a good bowel preparation prior to the capsule endoscopy. It should take 6-8 hours on an average for the capsule to reach the colon. If the transit is so slow that the capsule examines only part of the small intestine before the battery fails, the study will remain incomplete. Often, the life of the battery may last till 12 hours; so the test can go beyond 8 hours if it is found that the entire small intestine has not been crossed.

The small bowel is 12 feet long. If a finding is seen that require surgical resection or further investigation, the capsule cannot mark or ‘flag’ that point so that it will get seen in surgery.

Going through the tens of thousands of photographs is very time consuming, and needs a conscientious reviewer. Reporting could take 2-3 days as it is huge data. You will get printed report and CD of the procedure.

Are there any risks in Capsule Endoscopy:

The capsule can get stuck in the narrow area (this is called Capsule Retention) and though it may not cause obstruction of the intestine, it may require surgical removal. Capsule retention happens only 0.75% times as we have ways to prevent it. In patients who are suspected of having a stricture, a self-dissolving, dummy ‘Patency 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 from the capsule will resolve without surgery, and the real capsule will not be used. It is important that you follow the instructions below for your physician to be able to get accurate information.

Consultation prior the Capsule Endoscopy:

The Clinical Consent: The Gastroenterologist will see you; and confirm that the Capsule Endoscopy is appropriate test to be done, is safe as well as will serve the purpose of giving your diagnosis. You will need to show your other illness records (diabetes, hypertension & cardiac disease, thyroid illness, etc); the medications you concurrently use on a daily basis, as these will have to be rescheduled on the day of the test. There may be some medications that could be safely stopped during the time of this test (iron & supplements). You will be explained the appropriate Bowel Preparation to cleanse your intestine; as well as what time to take this. To save costs, this is easily done at home prior arrival. If the patient is visually challenged; has a difficulty with use of a commode; or is too weak, you may prefer to admit for the bowel preparation itself.

The Financial Consent:

the Office will appraise you about the costs of the test, expenses incurred during the stay; and any other expenses if applicable. In case you have paperwork regarding your Medical Insurance, you could get it cleared at this instance. Make sure you have understood all of this as you would not wish a delay in starting the test for administrative reasons.

Medication and advice for the night prior and morning of the test:

Your doctor will go through the following check list:

Time of the last meal in the evening before.
Timing of all the medications you usually take in the evening as well as the night.
If you are regularly using a night time sedative, whether you could take it on this night too.
Timing of starting the Bowel prep in the night / morning, as well as what prep to take.
Timing of any medication that you normally take in the morning empty stomach
Timing of morning doses of diabetic medication / insulin that you would normally take till 10 am.
Timing of reporting to the hospital in the morning.

The morning of the Capsule Endoscopy:

Report to the Casualty; the medical details will be attended by the Casualty doctor

medication taken;
any monitoring of co morbid conditions;
how well prepared the bowel is and should be;
completing the Consent process);

And the Admission formalities will be done by the Reception

Assigning the bed,
Completing the Medical File Record,
Finishing with the Admission Deposit.

Your arrival will be intimated to

the Consultant overseeing the procedure
your physician for co morbid illnesses
The Biomedical Department for preparing the Capsule equipment.
The Dietitian who will provide you diet requirements at the designated times.

You should be in your designated bed / room within an hour of reporting to the hospital.

How the test will start:

The staff nurse & ward doctors will be attending to you is you have any medical issue – difficulty in swallowing the capsule, any pain, queries regarding concurrent medication, any monitoring of vitals, blood sugar, etc.

The Sensor Belt will be applied to your abdomen and the Data Recorder will be attached to it; you will then be instructed to ingest the Pill Cam in the presence of the Medical Staff. He will confirm that the assembly is operational and recording properly. He will also instruct you how to check the recording is going on; who to call in case there is any doubt about equipment function; how to track the location of the capsule and progress.