Overview of Capsule Endoscopy

A Pill Camera Can Provide Physicians With Another Way Of Seeing The GI Tract

PillCam ESO 2 and SB 2
An example of the different types of capsule endoscopy pills that are on the market. Image © Given Imaging Ltd.

In traditional endoscopy, such as upper endoscopy, sigmoidoscopy, or colonoscopy, a thin tube (an endoscope) that has a light on the end is inserted into the body. In an upper endoscopy, the endoscope is inserted into the mouth in order to see the esophagus, stomach, and some parts of the small intestine. In a sigmoidoscopy or a colonoscopy, a sigmoidoscope or a colonoscope is inserted into the rectum in order to view the large intestine.

These tests are incredibly helpful in diagnosing and preventing digestive disease, but they also have drawbacks. In some cases these tests require sedation, preparation with laxatives or enemas, and can cause a certain amount of stress for patients. Some people may put off or avoid having these tests altogether because of potential embarrassment or discomfort, and therefore researchers are on the lookout for other ways to get a look inside the digestive tract.

The good news is that physicians and scientists understand that the more invasive tests are tough on patients. That's why, in some cases, a capsule endoscopy can be used instead. It's less invasive because patients swallow a pill that takes pictures before it is excreted from the digestive system. It can't be used for every situation, but it will be helpful for monitoring certain types of digestive disease.

What Is Capsule Endoscopy?

Capsule endoscopy was developed to address some of the difficulties in administering traditional endoscopy.

In capsule endoscopy, the digestive tract can be viewed through the use of a small camera that is inside a pill. The pill is swallowed by the patient, who then wears a belt that contains a receiver.

The receiver captures and saves the images sent by the camera pill as it travels through the digestive tract.

The patient can go about their day while the pill does its job. The receiver goes back to the physician for download and analysis of the images, and the pill passes in the patient's stool in a few days. Thankfully, the pill doesn't need to be retrieved or returned to the physician.

Capsule Endoscopy For Crohn's Disease Of The Small Intestine

In the United States, capsule endoscopy is approved for some specific purposes. In Crohn's disease, capsule endoscopy is approved for use in monitoring the small intestine. One drawback to an upper endoscopy is that it can not be used to access the entire small intestine. A capsule endoscopy, however, should be able to obtain photos throughout the small intestine, even accessing the portions that an endoscopy can not reach.

The drawback to capsule endoscopy, however, is that there is a small possibility of the capsule being retained in the small intestine. This can happen if there is a narrowing (a stricture) in the small intestine, which is not an uncommon occurrence in Crohn's disease. Physicians may first give patients a dissolvable "test" capsule to ensure it can pass all the way through the digestive tract before administering the actual camera pill.

Capsule Endoscopy For Colon Cancer Screening

Capsule endoscopy is also approved for use in screening the large intestine, but only in specific instances. There are a certain number of patients (anywhere from 5% to 10%) in whom a colonoscopy can not be completed. An incomplete colonoscopy can happen for a number of reasons, including the presence of a hernia or scarring (adhesions) from prior surgeries. In the United States, these patients might then be offered capsule endoscopy of the large intestine. Capsule endoscopy can locate the presence of polyps or other problems in the colon, but further interventions would be needed in order to remove a polyp or treat a disease.

If you have questions about using capsule endoscopy, talk to your doctor to find out more and if it's a test that's right for you.

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