Capsule endoscopy

 

Picture of a capsule

 

Endoscopic capsule end-on, showing six LEDs and camera lens.

Capsule Endoscopy is a term used to describe a miniature capsule used to record images through the digestive tract for use in medicine. The capsule is a camera with the size and shape of a pill used to visualize the gastrointestinal tract. The procedure was approved by the U.S. Food and Drug Administration in 2001.^[1] It is an imaging device for the detection of gastrointestinal diseases.

Contents 1 Uses 2 Recent developments 3 Footnotes 4 References 5 See also 6 External links

 Uses

Capsule endoscopy is used as a less-invasive procedure in placement of a traditional endoscope, which is a long, thin tube inserted into the rectum and transversed through the colon or into the oral cavity. The technology is used by gastroenterologists to detect diseases such as Crohn's disease, gastric ulcers, and colon cancer. At the present time, the capsule camera is primarily used to visualize the small intestine. Whereas the upper gastrointestinal tract (esophagus, stomach, and duodenum) and the colon (large intestine) can be very adequately visualized with scopes (cameras placed at the ends of thin flexible tubes), the small intestine is very long (average 20-25 feet) and very convoluted. No available scope is able to traverse the entire length of the small intestine. Because the capsule is swallowed and travels through the digestive system, capsule endoscopy takes a longer amount of time than traditional endoscopy. The images are of good quality, comparable to those from scopes. The test carries a high sensitivity and specificity for detecting lesions. Early research has shown that capsule endoscopy can detect evidence of disease in some cases that traditional endoscopy cannot.^[2][3][4]

 

 Recent developments

Much research is occurring in the United States, Israel, Japan, South Korea, and United Kingdom to improve capsule endoscope technology. Sayaka Capsule by RF System of Japan is an advanced capsule with power supplied wirelessly from an external source.^[5] In Japan, capsule endoscopy is now approved for use in the small bowel and in Europe, capsule endoscopy is being used for several areas including colon screening since July, 2007. The next major development is to enable the capsule to do other functions that are possible with current traditional endoscopes, besides just imaging with a camera. These include multiple therapeutic and diagnostic operations such as ultrasound, electrocautery, biopsy, laser, and heat with a retractable arm.^[6]

 

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WIRELESS CAPSULE ENDOSCOPY What if you were a plumber and couldn't find the leak? That is the situation that sometimes frustrates doctors asked to evaluate a patient with signs of iron deficiency anemia due to blood loss. There are many types of anemia. Iron deficiency anemia is a common type and most often occurs in pregnant women or menstruating women due to the monthly loss of blood. But when significant iron deficiency anemia occurs in women after the age of menopause or in men, it is often a sign of the loss of blood from somewhere else - usually the digestive tract. This blood loss may be very gradual and not visible to the patient. But over time, the continued loss of blood can deplete the body of iron and anemia develops. If a doctor suspects that anemia is due to intestinal bleeding, special tests are usually ordered to help the doctor "find the leak." This is a bigger task than most people realize since the average adult digestive tract is approximately 30 feet in length. The top 4 feet (Upper GI, or UGI TRACT) includes the esophagus (foodpipe) and stomach and first portion of the small intestine, called the duodenum. The bottom 6 feet makes up the COLON and rectum. In between, lies the rest of the 20 feet of SMALL INTESTINE where the process of digestion actually occurs.   Scope Tests In this situation, one of the first diagnostic studies ordered are special "scope" tests of the digestive tract. Gastroscopy is used to check the first 4 feet of the upper digestive tract (colored pink above) and colonoscopy to evaluate the colon and rectum (colored brown above). As you can see, most of the 20 feet of small intestine (colored green above) lies beyond the reach of these two studies. Fortunately, most bleeding problems seem to occur in the area than can be "scoped" and the source of bleeding is usually found and treated. Common problems would include hiatal hernia, gastritis, ulcers, polyps, and, sometimes, stomach or colon cancer. The Small Intestine - Uncharted Territory What if a patient had severe iron deficiency anemia and scope tests of the stomach and colon are normal? It is not uncommon for doctors to evaluate a patient with unexplained anemia and neither gastroscopy nor colonoscopy scope examinations reveal the diagnosis. By a process of elimination, it then becomes likely that the source of bleeding lies somewhere in-between - below the reach of the gastroscope and above the reach of the colonoscope - in the 20 feet of small intestine. How then is this area examined? Well, not very well. Gastroscopy and colonoscopy cannot reach this far. Contrary to popular belief, special imaging studies like CT scan or MRI are not useful in this circumstance. X-rays of the small intestine can be performed after drinking a chalky solution of barium. Called a small bowel series, this test has been available for many years, but has a limited accuracy. X-rays are still only shadow pictures and do not view the object itself like a camera. Why not use a longer scope? Since scope tests were first invented, doctors have wanted to be able to visualize the entire gut - all 30 feet. But, a direct view of the small intestine has remained elusive. Attempts have been made to develop longer endoscopic instruments. This technique called push enteroscopy has had only limited success. The longer instruments are difficult to control and manipulate and are hard to maintain. The accuracy of push enteroscopy is still limited since even in the best of hands the entire small intestine is not visualized. The Given Video Capsule - Hope For the Future In 1981, an Israeli physician, Dr. Gavriel Iddan, began development of a video camera that would fit inside a pill. Technology was not ready and the idea was put on hold. It took 20 years for technology to catch up with Dr. Iddan. In 2001, the FDA approved the Given Diagnostic Imaging System. This may sound like science fiction, but this 11 x 26 mm capsule weighs only 4 gms (about 1/7th of an ounce) and contains a color video camera and wireless radiofrequency transmitter, 4 LED lights, and enough battery power to take 50,000 color images during an 8-hour journey through the digestive tract. About the size of a large vitamin, the capsule is made of specially sealed biocompatible material that is resistant to stomach acid and powerful digestive enzymes. Another name for this new technique is Wireless Capsule Endoscopy. Patients report that the video capsule is easier to swallow than an aspirin. It seems that the most important factor in ease of swallowing is the lack of friction. The capsule is very smooth, enabling it to slip down the throat with just a sip of water. After the Given M2A capsule is swallowed, it moves through the digestive track naturally with the aid of the peristaltic activity of the intestinal muscles. The patient comfortably continues with regular activities throughout the examination without feeling sensations resulting from the capsule's passage. During the 8 hour exam, the images are continuously transmitted to special antenna pads placed on the body and captured on a recording device about the size of a portable Walkman which is worn about the patient's waist. After the exam, the patient returns to the doctor's office and the recording device is removed. The stored images are transferred to a computer PC workstation where they are transformed into a digital movie which the doctor can later examine on the computer monitor. Patients are not required to retrieve and return the video capsule to the physician. It is disposable and expelled normally and effortlessly with the next bowel movement.

Understanding Capsule Endoscopy

What is Capsule Endoscopy?

Capsule Endoscopy lets your doctor examine the lining of the middle part of your gastrointestinal tract, which includes the three portions of the small intestine (duodenum, jejunum, ileum). Your doctor will use a pill sized video capsule called an endoscope, which has its own lens and light source and will view the images on a video monitor. You might hear your doctor or other medical staff refer to capsule endoscopy as small bowel endoscopy, capsule enteroscopy, or wireless endoscopy.

Why is Capsule Endoscopy Done?

Capsule endoscopy helps your doctor evaluate the small intestine. This part of the bowel cannot be reached by traditional upper endoscopy or by colonoscopy. The most common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine. It may also be useful for detecting polyps, inflammatory bowel disease (Crohn’s disease), ulcers, and tumors of the small intestine.

As is the case with most new diagnostic procedures, not all insurance companies are currently reimbursing for this procedure. You may need to check with your own insurance company to ensure that this is a covered benefit.

How Should I Prepare for the Procedure?

An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink, including water, for approximately twelve hours before the examination. Your doctor will tell you when to start fasting.

Tell your doctor in advance about any medications you take including iron, aspirin, bismuth subsalicylate products and other “over-the-counter” medications. You might need to adjust your usual dose prior to the examination.

Discuss any allergies to medications as well as medical conditions, such as swallowing disorders and heart or lung disease.

Tell your doctor of the presence of a pacemaker, previous abdominal surgery, or previous history of obstructions in the bowel, inflammatory bowel disease, or adhesions.

What Can I Expect During Capsule Endoscopy?

Your doctor will prepare you for the examination by applying a sensor device to your abdomen with adhesive sleeves (similar to tape). The capsule endoscope is swallowed and passes naturally through your digestive tract while transmitting video images to a data recorder worn on your belt for approximately eight hours. At the end of the procedure you will return to the office and the data recorder is removed so that images of your small bowel can be put on a computer screen for physician review.

What Happens After Capsule Endoscopy?

You will be able to drink clear liquids after two hours and eat a light meal after four hours following the capsule ingestion, unless your doctor instructs you otherwise. You will have to avoid vigorous physical activity such as running or jumping during the study. Your doctor generally can tell you the test results within the week following the procedure; however, the results of some tests might take longer.

What are the Possible Complications of Capsule Endoscopy?

Although complications can occur, they are rare when doctors who are specially trained and experienced in this procedure, such as members of the American Society for Gastrointestinal Endoscopy, perform the test. Potential risks include complications from obstruction. This usually relates to a stricture (narrowing) of the intestine from inflammation, prior surgery, or tumor. It’s important to recognize early signs of possible complications. If you have evidence of obstruction, such as unusual bloating, pain, and/or vomiting, call your doctor immediately. Also, if you develop a fever after the test, have trouble swallowing or experience increasing chest pain, tell your doctor immediately. Be careful not to prematurely disconnect the system as this may result in loss of image acquisition.

Actor Surya Capsule Endoscopy Launch Pictures,Photo Gallery