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Updated on Sep 29, 2020 by Dr. Shawn Khodadadian (Gastroenterologist) of Manhattan Gastroenterollogy

What is capsule endoscopy?

Small Bowel Capsule
Endoscopy 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.  At Manhattan Gastroenterology, we offer service based on the indication and will be glad to speak with you about its uses in detail.

What can capsule endoscopy do it and why is it beneficial?

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.

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. Our gastroenterologists, GI doctors 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 12 hours, you will wear the monitoring device as the capsule moves slowly through your gastrointestinal tract.


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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

You should consult the physician performing this exam for specific instructions about your preparation given your particular case. 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 24 hours before the test and drink only water on the day of the procedure.  Some doctors suggest a laxative prior to the examination for better visualion.  You must speak with the performing gastroenterologist for specific instructions.  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. Please discuss your medication regimen with your doctor.

Capsule EndoscopyOn 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 approximately 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. Slow transit can also be a limitation. Sometimes the capsule moves slowly through the bowel and does not examine the entire small bowel before the battery dies. There may also be the possibility of missed lesions because of irregularities in areas of the small intestine that can be missed either because of inconclusive imaging or rapid transit.

Capsule Endoscopy Complications

Complications with this non-invasive procedure are uncommon and the test is contraindicated for some patients.  If the capsule does not make it through the entire small intestine, you may neeed an XR to make sure it was ultimately eliminated from your intestines.  You will need to discuss this with your doctor.

Although complications can occur, they are rare when the test is conducted by specially trained and experienced gastroenterologist. However, there can be limitations and complication with its use which may include the following:

  • Bowel obstruction-The most serious complication is if the capsule gets stuck inside your digestive tract in an area of narrowing resulting in a bowel obstruction that may require surgical removal. This can happen in a stricture, or narrowing, of your digestive tract from inflammation, prior surgery or tumor. It’s important to recognize the obstruction early from symptoms such as unusual bloating, abdominal pain, nausea or vomiting. Other complications include developing a fever after the test, having trouble swallowing or experiencing chest pain. Call your doctor immediately if you have any such symptoms.
  • Slow transit- Sometimes the capsule moves slowly through the bowel and does not examine the entire small bowel before the battery dies
  • Missed Lesions- There can be irregularities in areas of the small intestine that can be missed either because of inconclusive imaging or rapid transit

Call your doctor immediately if you have any such symptoms.  If you have had bowel obstructions or adhesions in the past, or if you have a pacemaker, please let your doctor know. Your gastroenterologist at Manhattan Gastroenterology should help decide if small bowel capsule is the right test for you in order to come to an accurate diagnosis and treatment plan.

Dr. Shawn Khodadadian has either authored or reviewed and approved this content.
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DISCLAIMER: PLEASE READ CAREFULLY

The information on this website is to provide general information. The information on this website does NOT reflect definitive medical advice and self diagnoses should not be made based on information obtained online. It is important to consult a best in class gastroenterologist for a consultation and examination regarding ANY and ALL symptoms or signs including abdominal pain, hemorrhoids or anal / rectal bleeding as it may a sign of a serious illness or condition. An accurate diagnosis and treatment plan should only be made by your physician in order to exclude a serious condition.