Capsule EndoscopyPillCam Capsule Endoscopy allows your doctor to examine your small intestine. For the examination you will swallow a vitamin-pill sized video capsule. This capsule has its own camera lens and light source. While the video capsule travels through your digestive tract, images are sent to a datarecorder you will wear on a waistbelt. Afterwards your doctor will view the images on a video monitor.
- 01. Reasons for the Exam
- 02. Equipment
- 03. Benefits
- 04. Side Effects and Risks
- 05. Alternative Testing
- 06. Preparation
- 07. The Procedure
01. Reasons for the Exam
The most common reason for the examination is persistent bleeding from the gastrointestinal tract with negative results on upper endoscopy (EGD), Colonoscopy and a small bowel follow-through x-ray. Other reasons for the examination include an abnormal x-ray of the small intestine, certain chronic conditions or in rare cases persistent abdominal pain.
Capsule Endoscopy is a revolutionary new technique to view the small intestine. There is up to 18 feet of the small intestine that cannot be directly seen with the endoscope or colonoscope. The capsule endoscope (M2A Capsule, Given Technologies) is a capsule the size of a multivitamin pill that is swallowed by the patient. The capsule takes two video images each second. The capsule sends the video images by radio waves to electrodes that are taped to the abdomen.
Capsule Endoscopy allows examination of an area of the intestinal tract that could not be directly visualized previously. This is only a diagnostic test, meaning, you cannot biopsy or treat with a laser through the capsule. However, it can prevent unnecessary surgery or repeated examination with upper endoscopy and or colonoscopy.
04. Side Effects and Risks
Examination of the small intestine with capsule endoscopy is generally safe. Complications are uncommon. Risks and complications include but are not limited to the following.
In approximately 1 out of 100 procedures, the capsule can become lodged above a stricture or narrowed area. Patients who have Crohn’s disease or have had abdominal surgery in the past are at increased risk for this complication. If an obstruction or stricture prevents passage of the capsule, surgery may be required for removal, with the associated risks of bleeding, infection, prolonged hospitalization and even death. An abdominal x-ray may be ordered in the weeks after the procedure if the physician is not able to determine that the capsule passed into the large intestine during the course of the study.
There have been reports of the capsule becoming lodged at the back of the throat. Should this occur, it may need to be removed by a physician.
There is a risk of aspiration (swallowing the capsule accidentally into the lung). Should that occur, pneumonia and other complications could result. .
Patients who have difficulty swallowing may be at increased risk for complications. It is important that you notify the nursing staff or physician prior to the capsule endoscopy procedure if you have difficulty swallowing. .
The capsule is not approved for use in patients with pacemakers or implanted cardiac defibrillators. The capsule has been used in some centers in these patients without complications related to the pacemaker or implanted defibrillator. .
Due to variations in the patient’s intestinal motility, the capsule may only image part of the small intestine. It is also possible that due to technical factors, including but not limited to food debris in the intestine and device malfunction, some images may be inadequate and this may result in the need to repeat the capsule procedure. .
Due to the metallic components of the capsule, MRI studies should not be performed until the capsule has passed out of the body. If you require an MRI study, notify the ordering physician that you have recently had capsule endoscopy and that the capsule must be passed out of the body before the MRI is performed. .
Capsule endoscopy is not a perfect study. Abnormalities, including cancer, might not be seen in some cases.
05. Alternative Testing
Small bowel enteroscopy using a standard endoscope is an alternative to examination of the small bowel, but cannot view the entire small bowel, as is the case with capsule endoscopy. Small bowel x-rays can view the entire small bowel, but are much less accurate. Should you have questions regarding alternative ways to examine the small intestine, please be sure to ask the nurse or physician at Dayton Gastroenterology before proceeding with the capsule exam.
Do not take iron for 4 days prior to your procedure.
The day before the Capsule Endoscopy:
After lunch on the day before the Capsule Endoscopy examination, start a clear liquid diet. Clear liquids are any liquid that you can see through. Avoid any red liquids or alcoholic beverages.
- 01. CLEAR LIQUIDS INCLUDE:
- • Water
- • Clear fruit juices such as apple or white grape
- • Bouillon or clear broth
- • Jell-O without fruit added – no red flavors
- • Gatorade – no red flavors
- • Popsicles – no red flavors
- • Coffee and tea without milk or creamer
- • Carbonated beverages such as Coke, 7-Up, Mountain Dew, etc.
- • Hard candy (lemon-lime or orange life savers, or other clear hard candy)
- 02. At 7 p.m. the afternoon before the Capsule Endoscopy, drink one 10 ounce bottle of Citrate of Magnesia (available over the counter at any drug store).
- 03. From 10 p.m. the evening before the Capsule Endoscopy, do not eat or drink except for necessary medication with a sip of water.
- 04. Abstain from smoking 24 hours prior to undergoing Capsule Endoscopy.
Male patients should shave their abdomen 6 inches above and below the navel on the day before the examination.
Day of Capsule Endoscopy:
Have nothing to eat or drink before your Capsule Endoscopy. Do not take any medication beginning 2 hours before undergoing Capsule Endoscopy.
Arrive at the Meenakshi Gastro Liver care dressed in loose fitting, two-piece clothing.
Do not eat or drink after midnight the night before your examination.
07. The Procedure
On the day of the procedure you will have an appointment with a nurse. Before you swallow the capsule she will tape 6 electrode sensors on your abdomen. These sensors are connected to the data recorder that you will wear at your waist.
After ingesting the M2A Capsule:
After ingesting the M2A Capsule, do not eat or drink for at least 2 hours. You may have clear liquids 2 hours after ingesting the capsule and take any medications. After 4 hours you may have a light snack. After the examination is completed and the equipment is removed, you may return to your normal diet.
After ingesting the M2A Capsule and until it is excreted, you should not be near any source of powerful electromagnetic fields such as near an MRI device or amateur (ham) radio.
Capsule Endoscopy lasts approximately 8 hours and is considered complete according to your physician’s instructions. Do not disconnect the equipment or remove the belt at any time during this period. Since the Data Recorder is actually a small computer, it should be treated with utmost care and protection. Avoid sudden movement and banging of the Data Recorder.
You can go to work or engage in your usual daytime activities. Avoid any strenuous physical activity especially if it involves sweating and do not bend over or stoop during Capsule Endoscopy.
You will return to Dayton Gastroenterology at four o’clock in the afternoon. The sensors will be removed and the images from the data recorder will be downloaded into a computer. A physician will review the video within several days and a report will be sent to your doctor.