Video capsule endoscopy is a procedure that allows a doctor to examine your small intestine for sources of bleeding. It may be especially helpful for diagnosing Crohn's disease.
Capsule Endoscopy involves swallowing a small (the size of the large vitamin pill) capsule, which contains a colour camera, battery, light source and transmitter. The camera takes two pictures every second for eight hours, transmitting images to a data recorder about the size of a portable CD player that patients wear around the waist. Capsule endoscopy assists in diagnosing gastrointestinal conditions in the small bowel such as: bleeding, malabsorption, chronic abdominal pain, and chronic diarrhoea. Once swallowed the camera moves naturally through the digestive tract. Approximately eight hours after ingesting the camera, patients return to the Endoscopy Unit where the recording device is removed by the nurse, the images are downloaded to a computer and evaluated. The Capsule is disposable and will be passed naturally in the bowel movement.
What are the advantages?
Video capsule endoscopy is becoming popular because it has several advantages over traditional endoscopy:
• the capsule is easily swallowed
• it is painless and sedation free during the procedure
• the patient can relax in comfort and walk about, without a hospital stay
• exposure to potentially harmful radiation does not occur
• additional investigations can often be avoided
• It can show the entire small intestine and thus may be better at finding sources of bleeding.
• It is not invasive. In traditional endoscopy, a thin, lighted tube is inserted down your throat.
• It is painless, so you do not need to take pain medicine.
• You do not have to stay in the hospital.
• You have to fast for 12 hours before swallowing the capsule, but it does not require other preparation.
What Happens During Capsule Endoscopy?
The diagnostic procedure is almost as simple as swallowing a pill the size of a large vitamin tablet, but this capsule contains lights, a wireless transmitter and a camera housed in clear plastic. Your doctor will fit you with a monitoring device to wear as the pill moves through you. Some monitors are connected to adhesive patches the doctor will place on your abdomen. For the next 8 to 12 hours, you will wear the monitoring device as the capsule moves slowly through your gastrointestinal tract.
You will not feel any unusual sensations during the test, but the camera you have swallowed will be working overtime. During a typical test, the camera takes about 50,000 pictures of your stomach and intestinal walls. Like a camera flash, the LED lights in the capsule provide light for the images the camera takes and transmits to the compact monitoring device you wear.
After the wireless camera completes its tour of your stomach, small intestine and colon, it is expelled. The capsule may emerge after a few hours, or it may not make its reappearance for up to 72 hours; both possibilities are normal. The camera is disposable and can be flushed, so you do not need to retrieve it. The information it gathered is stored in the monitoring device, not the capsule.
How to Prepare for Capsule Endoscopy
The camera capsule works best in an environment free of matter that could obscure the lens, so your doctor will probably recommend that you consume only clear liquids for 12 to 24 hours before the test and drink only water on the day of the procedure. Talk with your doctor about any medications you take; some of them may have to be adjusted or temporarily discontinued for your test. Some common medications, including non-steroidal anti-inflammatory medications, aspirin, bismuth subsalicylate antacids and iron supplements, can obscure test findings.
On the day of the procedure, your doctor will apply the adhesive sensors that detect the camera’s transmissions and send them to the recording device. The monitoring device is about the size of a small compact disc player and attaches at the waist with hook-and-loop fasteners. Once your monitoring system is in place, you are ready for the camera capsule.
The pill-sized camera is no larger than a typical multivitamin tablet and should be easy to swallow for most patients. It has a slippery coating to help it go down more easily, and after the doctor sees that the capsule is in place and functioning, you can leave the office. Follow your doctor’s instructions about eating and drinking while undergoing capsule endoscopy. Generally, you can have clear liquids for the first two hours after swallowing the tablet and a light meal four to six hours after starting the procedure. Your doctor may ask you to avoid strenuous activity that could lead to blurred images, but otherwise, you should be able to go about your usual routine until the test is complete.
What to Expect After the Procedure
When the test is finished after 8 to 12 hours, you can remove the sensor patches and pack them with the monitoring device according to your doctor’s directions. After your doctor uploads the images and analyzes them, you will receive the results of the test. In most cases, you will get a call about your results within a few days to a week, but some diagnoses take more time.
Advantages of Capsule Endoscopy
Because you need no anesthesia for capsule endoscopy, the procedure involves no recovery time. For many patients, swallowing a pill is considerably more pleasant than undergoing conventional endoscopy. The middle portions of your gastrointestinal tract are difficult to see by other means, but capsule endoscopy creates a detailed, up-to-date image of your intestinal lining. Conditions that can be challenging to diagnose by other means are often readily revealed by capsule endoscopy.
Limitations of Capsule Endoscopy
Your doctor may recommend additional tests to compensate for the limitations inherent with capsule endoscopy. Because the wireless camera capsule is not under voluntary control, the images it records may not highlight an area of interest sufficiently, necessitating further testing. Unlike traditional endoscopy, the camera can only record, so taking a biopsy or removing a polyp is not possible with this procedure.
Capsule Endoscopy Complications
Complications with this non-invasive procedure are rare, but it is contraindicated for some patients. If you have a permanent pacemaker, tell your doctor; you may need to undergo your capsule endoscopy in the hospital so you can be monitored throughout the procedure. If you have had bowel obstructions or adhesions in the past, let your doctor know. Bowel narrowing or obstruction can cause the capsule to lodge in the gastrointestinal tract.Your doctor may recommend additional tests before performing a capsule endoscopy if you have symptoms of bowel obstruction. If you notice bloating, abdominal cramping, nausea or vomiting after the test and have not yet passed the capsule, contact your doctor immediately.