Capsule Endoscopy near Malvern, PA
Video capsule endoscopy is a new noninvasive technology designed for visualization of the small intestine. The small intestine is approximately 18 feet long. The first one to two feet (duodenum) can be visualized by upper endoscopy and the last several inches (terminal ileum) sometimes is seen on colonoscopy. The remainder of the small intestine is usually not seen during conventional. Capsule endoscopy allows photographic visualization of the entire small intestine.
Reasons to have a Capsule Study
The full range of indications has yet to be defined since it is a new technology and there have been no large studies of its effectiveness. However, the main indications for the study will probably be those listed below:
- Gastrointestinal Bleeding: The majority of bleeding from the GI tract occurs from the esophagus, stomach, duodenum, or colon. These sites are visualized by conventional upper endoscopy and colonoscopy. In those cases where the site has not been found after upper endoscopy and colonoscopy, video endoscopy can be done to locate a small bowel source.
- Crohn's Disease: In a select group of patients with this disorder, the capsule endoscopy may be utilized to determine the extent and location of disease.
- Small bowel tumors and surveillance: It may be useful in the detection of small bowel tumors.
- Other potential indications: It may be useful in evaluation of malabsorptive conditions such as celiac sprue and chronic diarrhea
- Abnormal small bowel x-rays: Abnormalities identified on a small bowel series can sometimes be better characterized by a capsule study.
Risks of the Procedure
The most common complication is retention of the capsule above a stricture (narrowed area) in the small intestine. This usually requires surgery for removal of the capsule. However, the stricture is then usually treated and corrected at the time of surgery. While the capsule is in your body you are not allowed to be in close proximity to an MRI machine.
Description of the Procedure
Patients come to the office in the morning usually between 7:00-8:00AM. They are fitted with the leads, which appear similar to that of an EKG. A vest with the data recorder is then fitted to the individual patient. After drinking a glass of water, the patient removes the capsule from the protective covering and swallows it with another glass of water. Nothing is taken orally for two hours; then liquids are permitted. Four hours after capsule ingestion, solid food is permitted. The capsule takes two images per second and transmits these images in a wireless fashion to the data recorder fastened in the vest. The recorder acquires up to 50,000 images over a 7 hour period. The patient then returns in the afternoon where the vest, data recorder, and leads are removed. The images are downloaded to a computer. The capsule is passed on its own and not retrieved.
Preparation for the Procedure
The day before the procedure, the diet is limited to clear liquids. The patient fasts after midnight. In some cases, a medicine may be given to the patient just prior to the administration of the capsule to facilitate passage of the capsule from the stomach. Patients are asked to take all their regular medications, two hours after capsule ingestion.
Capsule endoscopy does not permit tissue sampling. The exact location of abnormalities found may not be apparent. If the capsule moves too slowly through the intestine, it may not reach the area of abnormality before the seven hour time period for recording expires. If there is a known small intestine stricture, it should not be used unless there is a plan in place for possible surgery. In addition, the accuracy of the results has not been adequately verified by large studies.
Barium studies of the small intestine (small bowel follow through) may identify strictures and evidence of Crohn's disease. They rarely identify a bleeding source. Small bowel enteroclysis (a barium study of the small bowel in which a tube is passed through the nose, esophagus, stomach, and into the small intestine) may be as accurate as the capsule endoscopy in finding polyps and tumors but is more uncomfortable. Push enteroscopy (an upper endoscopy with a longer endoscope) may enable direct visualization of the first half of the small bowel.