Capsule Endoscopy
Last updated on November 15th, 2024 at 11:33 am
Capsule Endoscopy, also known as small bowel endoscopy is a procedure done to capture images of an individual’s digestive tract using a tiny wireless camera.
Capsule endoscopy is performed by only a professional Gastroenterologist in Nepal or anywhere around the world.
This process of endoscopy is done to collect image data of the inner part of an individual’s small intestine, which is a difficult area to reach through other endoscopy procedures.
How is Capsule Endoscopy performed?
In this style of endoscopy, a pill that is as small as the size of a vitamin capsule containing a video camera that can be swallowed without much difficulty is given to a patient by his/her physician.
The device has its own source of light and as it moves through the patient’s digestive tract it collects thousands of videos and still images, these images are passed on to a recording device that one has to wear outside their body.
The image data collected by the device is used by medical professionals to formulate proper diagnoses of the small intestine of their patients.
Types of Capsule Endoscopy
There are many types of capsule endoscopy available differing by the mechanical parts used to create them, one of them being a similar device that does not involve a recorder but instead, it stores the data collected in its internal storage system; which indisputable means that the device needs to be recovered after passing through the body to collect the recorded data.
The former kind of capsule endoscopy is more popular as it does not require the process of retrieving the device for data transmission.
Background of Capsule Endoscopy
Twenty-two years ago the first model of Capsule Endoscopy was introduced to the world by Given Diagnostic Imaging, Yokneam, Israel, (in the year 2000), it was primarily known as M2M, meaning mouth to anus.
Gavriel Idden, an Israeli engineer, and Paul Swain, a British Gastroenterologist, were the design pioneers; it took them twenty years to fully develop the product.
A year after the invention of the device it gained approval for clinical usage in Europe and The United States of America. Later after the birth of esophageal CE, M2M was renamed to PillCam SB (PillCam small bowel).
The invention of capsule endoscopy overruled the previous drawback of the difficulty of examining the inner part of the small bowel system.
Therefore, capsule endoscopy is a painless diagnostic procedure with minimal invasion, making it one of the most sorted after examination techniques among medical professionals and patients alike, though it has its own set of drawbacks like lack of motion control and chances of performing biopsies or giving drugs.
Who can recommend Capsule Endoscopy?
Capsule endoscopy is often suggested by gastroenterologists in Nepal or any part of the world.
Gastroenterologists are medical professionals who specialize in diagnosing and treating any health problems related to digestive systems.
Their area of expertise covers the whole digestive system including the esophagus, stomach, small intestine, large intestine, rectum, and anus, and also includes the pancreas, liver, bile ducts, and gallbladder.
Capsule endoscopy can be done in a doctor’s office, general gastroenterology clinic, or a hospital.
Medical usage of capsule endoscopy
A medical professional might suggest a capsule endoscopy to diagnose:-
- Crohn’s disease
A gastroenterologist can suggest this procedure to diagnose diseases relating to inflammation of the small intestine (like Crohn’s disease), it helps visualize the area of inflammation that can not be seen otherwise.
- Celiac Disease
It helps find the cause of gastrointestinal bleeding. The most common usage of capsule endoscopy is to find out the cause of unexplained bleeding by inspecting the small intestine internally.
- Ulcerative Colitis
Capsule endoscopy can be used by a medical professional to diagnose Celiac Disease by observing an individual’s immune reaction to gelatin intake.
- Tumors
Another usage of capsule endoscopy is to find the tumor that might exist in the small intestine or the other parts of the digestive system.
- To diagnose varices in the digestive tract
A Gastroenterologist can also suggest capsule endoscopy to examine the esophagus: a muscular tube that connects an individual mouth and stomach to search for abnormalities such as enlarged veins known as varices.
- To diagnose polyps in the digestive tract
Occasionally people who have congenital syndrome which can cause polyps in the small intestine are recommended capsule endoscopy by their doctor.
Who are eligible to get capsule endoscopy done?
Though capsule endoscopy is a safe and non-invasive medical procedure, individuals who are pregnant, have cardiac pacemakers or any other sort of electro-medical devices installed, are known to have swallowing disorders or are suspected to have gastrointestinal obstruction, gastrointestinal strictures, or are known to have fistulas based on previous medical reports are advised to not go for this procedure.
Capsule endoscopy is also not FDA-approved for children.
Capsule endoscopy should be only done in an environment with medical professionals and experts, the patients should have necessary documents supporting the need for the medical procedure. He/she should have the documents ready when called for.
If there is a noticeable drop in hemoglobin or hematocrit and the reason for its occurrence is not clear through other forms of diagnosis like gastroscopy or colonoscopy then a medical professional can find his/ her patient eligible to go for capsule endoscopy.
Another reason a medical professional can ask his/ her patient to go for a capsule endoscopy can be unnatural or overt gastrointestinal bleeding that can be an indication of iron deficiency yet it has not been proven to be definite through other diagnostics procedures.
Capsule endoscopy should only be performed in an environment where medical professionals are present and only if a doctor has recommended the procedure.
Previous medical reports, as well as a doctor’s recommendation, should be presented when called for.
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Preparation for the procedure
Before going through the procedure a medical professional will instruct his/her patient to follow a set of guidelines, if an individual fails to do so he/she might be rescheduled to go through the procedure.
Stop smoking
An individual is asked to stop smoking for at least 24 hours before the test.
Drink enough liquids a day before the procedure
An individual is asked to drink enough liquids a day before the test but he/ she is also asked to refrain from drinking colored liquid.
Laxative before the procedure
Before moving forward with the procedure an individual is asked to take a laxative few hours to clean the digestive tract so that the surface of the intestine is seen clearly.
Not to eat before the procedure
A medical professional can ask his/her patients to skip breakfast on the day the procedure is to be performed.
Fast for twelve hours before the procedure
Some medical professionals can ask their patients to fast for at least twelve hours, meaning an individual is asked to not eat and avoid drinking anything, doing so the images captured by the camera are more clear.
Clean the areas where sensors will be attached
An individual can be asked to shave an area where the sensor that transmits data from the capsule is to be attached so that the device can stick without any issues. That area can be the chest or the belly of the individual.
Inform the doctor about the medication the patient is taking
A medical professional will ask his/her patient to disclose the medication that they take, important medication can be taken two hours prior to the test as per the doctor’s instructions.
At times certain kinds of medication intervene with the procedure, hence an individual can be asked to not take them, and they can be asked to wait for hours before moving forward with the test.
Wear loosely fitted clothing articles on the day of the procedure
It is recommended that an individual wears loose clothing so that it will be easy to put on the electrodes and the transmitter patch, these patches have an antenna with wires that connect to a recorder on them, though some capsules endoscopy does not require the patches.
What to expect in a doctor’s office?
When a patient arrives at the doctor’s office for the test a medical professional will fit his/her patient with all the necessary devices needed to transmit data from the capsule. Two main devices are put on the patient externally:-
1. Sensor
A sensor is put on an individual’s body to receive data from the capsule.
There are two types of sensors, the kind of sensor that would be used in the process depends upon what kind of capsule is being used according to the doctor’s recommendation.
Sensor array – A sensor array is stuck on the chest and belly of an individual using a gentle sticky substance, making this process painless. (This sensor has multiple electrodes)
Sensor belt – A sensor belt is worn around an individual’s waist, the belt has built-in electrodes, and it also contains all the wires inside it.
2. Recorder
A recorder that transmits the data from the capsule is given to the patient, it is worn with the help of a special sling or with the help of a harness across the shoulder or the chest.
The sensor sends the data from the capsule to the recorder for data storage purposes.
After all the devices are properly placed on an individual, the health professional will finally give his/her patient an activated capsule and some water to help swallow the device.
What to expect after taking the capsule?
- When an individual is going through a capsule endoscopy test he/she can continue his/her day as she/he might, but few activities should not be performed, any activity that involves heavy lifting, and any kind of intense exercises is to be avoided.
More detailed information will be given by a medical professional, and the individual is recommended to share the details about the activities they have planned for the day with the medical professional who is performing the test.
- A health professional will teach his/her patient about how to check the recorder and how often it should be checked, to see if it is receiving signals from the capsule or not.
If it looks like the recorder is not working then it is advised to contact the health professional who is performing the test.
Diet after Capsule Endoscopy
While returning to one’s normal diet a health professional will give a set of guidelines to be followed.
- The first hour after swallowing the capsule nothing is to be eaten.
- After it has been two hours of swallowing the capsule the patient can drink water.
- After four hours of swallowing the pill, the patient can have some light snacks.
- Six to eight hours after swallowing the capsule all kinds of liquid are allowed, which also include fruit juice, soup, and broth.
- Eight hours later a light snack is recommended.
If the patient feels any kind of uneasiness like vomiting, nausea, cramps, or pain in the belly region while they still have the capsule inside their system, they are urged to call their doctor immediately.
- After eight hours of swallowing the capsule, the patient is asked to return the devices attached to their body (electrodes or belt and the recorder).
If the patient has bowel movements sooner than that then the devices can be returned earlier.
Retrieving the Capsule
The capsule can be flushed down the toilet until and unless the medical professional has used a capsule with internal storage. If a capsule with internal storage has been used then the capsule is to be retrieved.
If the capsule does not appear in the first bowel movement after swallowing it then there is no need to be worried it should pass out of the system the next day or other.
The capsules pass out of the system by a maximum of five to seven days, if it does not it is recommended to contact a medical professional.
Precautions to take during Capsule Endoscopy
While the capsules inside the system are recommended to:-
- Avoid coming close to any powerful electromagnetic source, such as magnetic MRI machines, HAM radios, airports, and government buildings where the magnetic field is strong; as it might cause interference with the procedure.
Cell phones and computers can be used.
- Strenuous activity, bending, and sudden jarring movement should be avoided.
- Any tampering with a recorder should not be done.
- It is recommended to check one’s bowel movement while going through a capsule endoscopy test to see if the capsule has left the body prematurely.
Is there any risk associated with Capsule Endoscopy?
Capsule Endoscopy is a safe procedure but it has risks of its own, there is a slight possibility of the capsule getting lodged in the digestive tract rather than leaving the body from bowel movement within several days.
Though the chances of such occurrence are low, people who have a tumor, Crohn’s disease, or have had surgery that causes a narrowing in the digestive tract are at more risk of the capsule getting stuck than others.
If an individual is experiencing abdominal pain or might be at risk of having a narrow intestine, a doctor will most likely recommend a CT to inspect the intestine for narrowing before using capsule endoscopy.
As said before even if there is no narrowing the chances of the capsule getting stuck are there but they are very low.
If the capsule does not pass through the bowel movement but if it does not show any signs or symptoms of causing any trouble in the digestive tract then the medical professional might wait for a few more days for the capsule to pass out of the body on its own.
But if the capsule is causing any kind of bowel obstruction or is indicating symptoms of causing bowel obstruction it is immediately removed by surgery or by traditional endoscopy procedure, depending upon the location where the capsule is stuck.
Limitations of Capsule Endoscopy
Though the invention of capsule endoscopy helped doctors get an insight into areas that were once hard to examine and diagnose it still isn’t perfect.
A capsule endoscope is a non-invasive procedure that needs little manual assistance while being performed
- This means the camera takes pictures automatically and it keeps moving and does not focus, or remain and inspect the areas that look suspicious. In short, it lacks control.
- The contents of an individual’s digestive tract, mucus, and bubbles might create obstacles for the camera to capture the surface of the digestive tract clearly.
- The camera can not see through the folds, hence it may not be able to capture them and those areas remain hidden.
Because of the reasons stated above, there are chances of insufficient image data of a potential problem area because of which a medical professional may not be able to confidently interpret the results of the diagnosis, and other tests may be ordered to give a proper report.
Conclusion
Capsule endoscopy is a painless, non-invasive method of endoscopy that takes multiple image data as it moves along the digestive tract.
It should only be done when a doctor recommends it. Though it is a revolutionary invention, it has its own setbacks.
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References https://www.hopkinsmedicine.org/gastroenterology_hepatology/clinical_services/basic_endoscopy/capsule_endoscopy.html https://www.uofmhealth.org/conditions-treatments/digestive-and-liver-health/capsule-endoscopy https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/capsule-endoscopy?amp=true https://www.hopkinsmedicine.org/gastroenterology_hepatology/clinical_services/basic_endoscopy/capsule_endoscopy.html https://www.mayoclinic.org/tests-procedures/capsule-endoscopy/about/pac-20393366 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5438796/
