Capsule Endoscopy For Crohn's Disease

A Camera Inside A Pill Is Used To Monitor Crohn's Disease In The Small Intestine

PillCam SB 2 Capsule
The PillCam SB is used to monitor the small intestine, and is especially helpful for those with Crohn's disease. Image © Given Imaging, Ltd.

How Does Capsule Endoscopy Work?

Capsule endoscopy is exactly what it sounds like -- a pill (capsule) that contains a camera. After the pill is swallowed at a doctor's office, it takes photos as it travels through the small intestine. Patients wear a belt that receives a transmission from the pill, and records the images. The next day, the patient can return the belt to their physician, who then retrieves the images.

The images taken by the pill can give a physician a very good idea about what areas of the small intestine are displaying any disease activity. This can help in monitoring the progression of the disease, as well as in devising a treatment plan. Some of the risks are that the camera could get stuck in the intestine or that it could be too difficult to swallow.

Who Is A Candidate For Capsule Endoscopy?

Capsule endoscopy is approved for use in people who have Crohn's disease in the small bowel. It can be used in both children and adults. Capsule endoscopy may be used alone, or after another test, such as an upper endoscopy.

In some cases of Crohn's disease, the inflammation is located only in the small intestine -- the large intestine does not display any signs of disease. For these patients, capsule endoscopy may be used to monitor their Crohn's disease.

Who Is Not A Candidate For Capsule Endoscopy?

For some people, a pill won't be the best choice to see the inside of the small intestine.

The capsule that contains the camera is very small, but there is approximately a 2% chance that it could be retained in the small bowel (that the pill could get "stuck"). Having an intestinal blockage, a stricture, or a fistula can prohibit the capsule from passing all the way through the digestive tract.

If the capsule is retained, treatment may be necessary in order to allow it to pass, or to retrieve it.

Other conditions that prevent the use of the capsule endoscopy are swallowing disorders and heart conditions that require the use of a pacemaker.

What Are The Risks Of Capsule Endoscopy?

In some people, the capsule may not be able to pass all the way through the small intestine. The capsule has a small chance of getting "stuck" if there is a blockage or a narrowed section in the small bowel. If the capsule does not pass, a patient will need to be monitored closely. In some cases, administering drugs that can help open up the blocked area may help the capsule to continue through the intestine.

There is also a small risk of aspirating (choking on) the pill while trying to swallow it. Some people have reported developing skin irritation after swallowing the capsule.

Why Use Capsule Endoscopy?

Crohn's disease can affect any part of the digestive tract, from the mouth all the way to the anus. Being able to visualize every part of the digestive tract is a difficult prospect.

There are several imaging tests that can look at different sections of the digestive tract: an upper endoscopy can give access to the esophagus, the stomach, and the upper small intestine; a colonoscopy can help a physician to see the rectum and the large intestine.

There is, however, a section of the small bowel that can't be reached with either an upper endoscopy or a colonoscopy. Capsule endoscopy may allow a physician to see any inflammation, bleeding, or other evidence of Crohn's disease activity in that area.

Is There A Prep With Capsule Endoscopy?

Yes, in order to undergo capsule endoscopy, the small bowel must be prepped beforehand. The prep, however, is fairly straightforward and usually requires no medications or enemas. First, starting at about midday the day before swallowing the capsule, a liquid diet should be followed. Patients must then fast the night before they are scheduled to swallow the capsule, typically starting at midnight. Typically, a regular diet can be resumed about 4 hours after swallowing the pill at the doctor's office. These are only guidelines, however, and the physician administering the test will give more specific instructions on how to prepare.

In some cases, a "test" pill might be given prior to the actual camera pill being administered. The test pill, called a patency capsule, will dissolve completely in the bowel, and is the same size as the real pill. Giving the test pill is entirely at the discretion of the prescribing physician, and may be given if there is a chance that the camera pill could get stuck in the small intestine. If the patency capsule passes through the bowel without incident, it could indicate that the actual camera pill will also pass.

How Long Does It Take To Pass The Capsule?

The test is completed about 8 hours after swallowing the capsule. For most people, the pill is passed with a bowel movement between 24 and 72 hours after it is swallowed.


Given Imaging Ltd. "PillCam SB for Crohn's Disease." 2016.

Albert JG. "Small Bowel Imaging in Managing Crohn's Disease Patients." Gastroenterol Res Pract. 2012; 2012: 502198.

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