Capsule Endoscopy
Small Bowel Capsule Endoscopy
Complete endoscopic examination of the small intestine has not been possible until now. Capsule endoscopy provides excellent visualisation of the entire small intestine using a pill-sized, video imaging, wireless capsule. Every capsule contains a camera, light source, batteries and transmitter. During the procedure the patient can move about and over 50,000 colour images are recorded onto a data-recorder worn on a belt around the patient's waist. The capsule passes through the small intestine as peristalsis occurs and is excreted naturally.
Benefits Capsule Endoscopy
Unlike more traditional investigations, capsule endoscopy avoids exposure to potentially harmful radiation. It is also comfortable and sedation free, as the capsule is easily swallowed by the patient. During the procedure the patient can walk about and relax. Importantly the key findings of multiple clinical trials show that capsule endoscopy is significantly superior for examination of the small intestine for a broad range of indications compared to small bowel enteroclysis and barium follow through, CT, MRI, push enteroscopy and ileoscopy.
Indications for Capsule Endoscopy
The main indications for capsule endoscopy include the investigation of iron deficiency anaemia when obscure gastrointestinal bleeding is suspected, and the diagnosis of early or suspected Crohn’s disease of the small intestine. In addition, capsule endoscopy has a high level of sensitivity for detection of benign and malignant small intestinal tumours; it is helpful in the evaluation of Coeliac disease (particularly refractory cases) and other malabsorption disorders that may lead to chronic diarrhoea and weight loss it can identify medication (e.g. NSAID) related small bowel injury and it provides an additional diagnostic facility for small bowel abnormalities requiring further investigation.
Preparation required for Capsule Endoscopy
Capsule endoscopy is patient friendly and preparation usually involves dietary modification only. On the day before the procedure, lunch is followed by clear fluids and then an overnight fast. The capsule is swallowed by the patient with some water in the morning. Unlike conventional endoscopy, no sedation or analgesia is necessary.
The Oesophageal Capsule
The oesophageal capsule is an alternative investigation for patients with gastro-oesophageal reflux symptoms who do not wish to undergo gastroscopy. The capsule is simply swallowed and does not require sedation. It examines the oesophagus for signs of hiatus hernia or acid damage that can lead to inflammation or ulceration (oesophagitis) or the development of Barrett’s oesophagus. The finding of Barrett’s oesophagus is important as this condition is believed to increase the risk of oesophageal cancer. The oesophageal capsule may also be used to identify oesophageal varices in patients with liver disease.
The Colon Capsule
The colon (large bowel) capsule is not yet available for patients. Trials are currently underway to determine its effectiveness. Should these show that the colon capsule accurately detects polyps or bowel cancer, then the colon capsule (which can be swallowed) may be an easy and more convenient way than colonoscopy to check the bowel for these disorders.
