Associate Professor John Lubel
BDS, FDS RCS (Eng), MBBS, MRCP (UK), FRACP, PhD, FGESA
Consultant Gastroenterologist and Hepatologist
Capsule Endoscopy (CE) is a procedure that allows visualisation of the small bowel. It is also known as a "PillCam" or "wireless endoscopy". The patient swallows a tiny camera that is shaped like a capsule and this capsule passes naturally through the bowel until it is passed naturally in the bowel motions. It is used predominantly to investigate for small bowel bleeding which can result in iron deficiency and anaemia. Before capsule endoscopy can be performed, subjects should undergo gastroscopy and colonoscopy to exclude a cause of bleeding in the upper and lower gastrointestinal tract. There is no need for an anaesthetic and the procedure is painless and relatively low risk. In some patients where there is suspected to be a narrowing of the intestines, it is possible for the capsule to become stuck and in some instances surgery has been necessary to remove the capsule. However, ANY patient with obstructive symptoms (nausea, abdominal distention and vomiting) should be investigated for intestinal blockages before embarking on a capsule endoscopy.
Why do I need this procedure?
A number of conditions can affect the small bowel. In order to confirm the diagnosis, direct visualisation of the lining wall (mucosa) is required. Once we have confirmed the diagnosis and graded the severity we can then suggest appropriate therapy.
Common indications for Capsule Endoscopy include (but are not limited to), iron deficiency (with or without anaemia), suspected small bowel pathology (polyp, tumour), and in certain circumstances an investigation for inflammatory bowel disease.
What do you need to do and bring with you on the day?
Wear comfortable, loose-fitting clothing
Bring reading material or other entertainment in case you have to wait
Bring your Medicare card and private health insurance details
Eating and drinking
In order to examine the small bowel it is best to have nothing to eat or drink for at least 8 hours before the procedure. Iron tablets should be stopped for two days prior to the procedure and only a fluid meal should be taken for supper the night before. Diabetic patients should withhold their diabetic medications during the starvation period. If you take insulin then you should discuss dose modification with your doctor prior to the procedure. If you are suspected of having problems with the motility of your intestinal tract (e.g. gastroparesis or intestinal dysmotility) your doctor may suggest taking some bowel preparation to improve the visibility of the small intestine mucosa.
What happens during the procedure?
On the day of the procedure, you will be asked to sign a consent form and will be fitted with a belt that holds a data recorder. In addition 8 sensors will be placed on the skin to track and record the signal emitted from the capsule. Once the capsule has been activated (you can tell because it starts flashing) the capsule is swallowed with a cup of water and some liquid to reduce bubbles (infacol). No fluid should be taken for 2 hours after the capsule is swallowed and no food for 4 hours after. Gentle activity is recommended as this may help with capsule movement through the small bowel. The patient will often be asked to stay around until the first images are transmitted. After this time the patient can resume normal daily activities and return to the doctors rooms in 8 hours for the belt and sensor leads removed.
After my procedure
The recorder is connected to a computer and the data is transferred to specialised software that allows review of all the images taken by the capsule. The capsule is for single-use and does not need to be retrieved. The capsule passes naturally in the stool in 1-3 days. Most patients are not aware that it has passed.
Risks of the procedure
Capsule endoscopy is very safe. Very few patients have difficulty swallowing the capsule (1 in 100) and in those situations it is possible to deliver the capsule using endoscopy whilst the patient is asleep. Rarely (1 in 100) patients will retain the capsule in their bowel, usually the capsule will eventually pass naturally. Retention of the capsule may be related to a narrowing of the small bowel due to disease or other anatomical abnormalities (such as a pouch).
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