Understanding Capsule Endoscopy

Endoscopy literally means “seeing inside” in Latin. The procedure allows your doctor to see the inner surfaces of your gastrointestinal tract. What makes capsule endoscopy, sometimes called a pill-cam, different from conventional tube endoscopy is the kind of camera involved. With capsule endoscopy, you swallow a tiny camera encased in a clear, smooth shell; the camera takes pictures of your digestive system as it moves down your esophagus, into your stomach and through your small intestine. As the pill-sized camera moves through your digestive system, it transmits thousands of images to a recording device you wear around your waist or neck.

What Can Capsule Endoscopy Do?

Traditional endoscopy and colonoscopy procedures give your doctor the ability to examine the upper and lower portions of your gastrointestinal tract, but seeing the middle portions, including the duodenum, jejunum and ileum of the small intestine, was once unreachable to cameras. Capsule endoscopy sheds light on the middle regions of the gastrointestinal tract without exploratory surgery. Swallowing the tiny camera can reveal the source of gastrointestinal bleeding, detect bowel inflammation from Crohn’s disease, find tumors and see ulcers.

People who may have celiac disease can benefit from this type of endoscopy to get a definitive diagnosis and monitor intestinal inflammation without an invasive procedure. Some gastroenterologists are also using colon capsule endoscopy to screen for colorectal abnormalities such as polyps and precancerous neoplasms.

What Happens During Capsule Endoscopy?

The diagnostic procedure is almost as simple as swallowing a pill the size of a large vitamin tablet, but this capsule contains lights, a wireless transmitter and a camera housed in clear plastic. Your doctor will fit you with a monitoring device to wear as the pill moves through you. Some monitors are connected to adhesive patches the doctor will place on your abdomen. For the next 8 to 12 hours, you will wear the monitoring device as the capsule moves slowly through your gastrointestinal tract.

You will not feel any unusual sensations during the test, but the camera you have swallowed will be working overtime. During a typical test, the camera takes about 50,000 pictures of your stomach and intestinal walls. Like a camera flash, the LED lights in the capsule provide light for the images the camera takes and transmits to the compact monitoring device you wear.

After the wireless camera completes its tour of your stomach, small intestine and colon, it is expelled. The capsule may emerge after a few hours, or it may not make its reappearance for up to 72 hours; both possibilities are normal. The camera is disposable and can be flushed, so you do not need to retrieve it. The information it gathered is stored in the monitoring device, not the capsule.

How to Prepare for Capsule Endoscopy

The camera capsule works best in an environment free of matter that could obscure the lens, so your doctor will probably recommend that you consume only clear liquids for 12 to 24 hours before the test and drink only water on the day of the procedure. Talk with your doctor about any medications you take; some of them may have to be adjusted or temporarily discontinued for your test. Some common medications, including non-steroidal anti-inflammatory medications, aspirin, bismuth subsalicylate antacids and iron supplements, can obscure test findings.

On the day of the procedure, your doctor will apply the adhesive sensors that detect the camera’s transmissions and send them to the recording device. The monitoring device is about the size of a small compact disc player and attaches at the waist with hook-and-loop fasteners. Once your monitoring system is in place, you are ready for the camera capsule.

The pill-sized camera is no larger than a typical multivitamin tablet and should be easy to swallow for most patients. It has a slippery coating to help it go down more easily, and after the doctor sees that the capsule is in place and functioning, you can leave the office. Follow your doctor’s instructions about eating and drinking while undergoing capsule endoscopy. Generally, you can have clear liquids for the first two hours after swallowing the tablet and a light meal four to six hours after starting the procedure. Your doctor may ask you to avoid strenuous activity that could lead to blurred images, but otherwise, you should be able to go about your usual routine until the test is complete.

What to Expect After the Procedure

When the test is finished after 8 to 12 hours, you can remove the sensor patches and pack them with the monitoring device according to your doctor’s directions. After your doctor uploads the images and analyzes them, you will receive the results of the test. In most cases, you will get a call about your results within a few days to a week, but some diagnoses take more time.

Advantages of Capsule Endoscopy

Because you need no anesthesia for capsule endoscopy, the procedure involves no recovery time. For many patients, swallowing a pill is considerably more pleasant than undergoing conventional endoscopy. The middle portions of your gastrointestinal tract are difficult to see by other means, but capsule endoscopy creates a detailed, up-to-date image of your intestinal lining. Conditions that can be challenging to diagnose by other means are often readily revealed by capsule endoscopy.

Limitations of Capsule Endoscopy

Your doctor may recommend additional tests to compensate for the limitations inherent with capsule endoscopy. Because the wireless camera capsule is not under voluntary control, the images it records may not highlight an area of interest sufficiently, necessitating further testing. Unlike traditional endoscopy, the camera can only record, so taking a biopsy or removing a polyp is not possible with this procedure.

Capsule Endoscopy Complications

Complications with this non-invasive procedure are rare, but it is contraindicated for some patients. If you have a permanent pacemaker, tell your doctor; you may need to undergo your capsule endoscopy in the hospital so you can be monitored throughout the procedure. If you have had bowel obstructions or adhesions in the past, let your doctor know. Bowel narrowing or obstruction can cause the capsule to lodge in the gastrointestinal tract.Your doctor may recommend additional tests before performing a capsule endoscopy if you have symptoms of bowel obstruction. If you notice bloating, abdominal cramping, nausea or vomiting after the test and have not yet passed the capsule, contact your doctor immediately.