NOTES ON…
Capsule endoscopy
This month, Katie Ford of County’s
End Veterinary Practice in
Saddleworth presents notes on
capsule endoscopy
C
apsule endoscopy has been
utilized in human medicine for
over 10 years and is noted to be
particularly useful in the
localization of gastrointestinal bleeding
following non-steroidal anti-inflammatory
(NSAID) administration. Although the
human devices had been experimentally
used in animals, it was the introduction of
a commercially available canine product
that has opened the door to its use in the
veterinary profession.
What is a capsule
endoscope?
■ A capsular device, approximately
2.5 cm in length (Figure 1)
■ Multiple cameras installed give a
360-degree view of the
gastrointestinal tract
■ Each individual camera takes
approximately 4 images/second
■ There is an internal light source to
provide high-definition images
Which patients are suitable
for the procedure?
■ There is a capsule endoscope
available specifically for canine
patients
FIGURE 1:
A commercially
available capsule
endoscope
specifically
marketed for
use in canine
patients.
(Courtesy of Infiniti
Medical)
35 Notes On.indd 35
FIGURE 2: Capsule endoscopy image revealing
■ Lower weight limits are patient-
dependent, but use has been
reported in dogs weighing as little
as 4.4 kg
■ There is no upper weight limit
■ The capsule is to be administered
orally so patients must have a
suitable temperament for this to
be tolerated
What does the procedure
involve?
■ A 24-hour starve is required prior to
the procedure
■ No anaesthesia or sedation
■ The capsule is administered orally,
similar to any other medication
■ The patient can be discharged for
monitoring at home, or some may
choose to hospitalize their pet
instead
■ A further 8-hour starve period after
administration
■ The device is retrieved from the
faeces, cleaned and returned by post
for interpretation
■ Images are retrieved, interpreted
and a full report generated within
48 hours
■ If the distal gastrointestinal tract is
of particular interest, the use of
prokinetic agents may be advised
to ensure recording capacity is
available
■ It has been reported that where the
colon is of particular interest, the use
of rectal micro-enemas prior to the
procedure increases success
How long does the
procedure take?
■ The capsule is generally passed
between 3 and 30 hours
■ It may be normal for the capsule to
be retained for over 72 hours; it is
advisable for clients to contact the
clinician if the capsule is not passed
after this time in order that a clinical
examination can be performed
■ Capsules contain radiopaque markers
to allow radiographic localization
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irregular gastric mucosa and an area of focal
gastric hyperaemia (arrowed).
In which clinical scenarios
would capsule endoscopy
be of benefit?
■ Localization of gastrointestinal
bleeding; particularly useful to
highlight instances where multiple
sites of bleeding are present
–– Early reports show capsule
endoscopy located a source of
bleeding in up to 100% of cases.
–– In one study, 25% of cases had
multiple sites of bleeding; for
example, gastric erosions (Figure 2)
and a colonic mass, with the
colonic changes potentially
missed if only conventional upper
gastrointestinal tract endoscopy
was performed
■ Assessment of gastrointestinal
transit time
■ Cases in which general anaesthesia or
sedation are contraindicated or need
to be avoided
■ Capsule endoscope has previously
been shown to show abnormalities
undetected on ultrasonography
■ For assessment of jejunal and ileal
mucosa, not visible with
conventional endoscopy
What are the disadvantages
of capsule endoscopy?
■ Tissue biopsies and subsequent
histopathology are not possible, so it
may be necessary to perform
conventional endoscopy or surgical
biopsy as well to reach a full diagnosis
■ In some cases, rapid gastric emptying
times may lead to limited images
■ Although rare, there is a risk of causing
gastrointestinal obstruction
The use of capsule endoscopy in
veterinary patients is being utilized more
widely, and preliminary work is becoming
available to highlight the scenarios in
which it is particularly beneficial. The
ability to image the gastrointestinal tract in
its entirety, without the need for
anaesthesia, is an advantage to the
clinician, patient and client. Although there
are limitations, its utility in cases with
gastrointestinal bleeding should be
particularly emphasized. 
References and further reading are
available online and in e-Companion.
© BSAVA 2017 ·  Companion JUNE 2017 · 35
18/05/2017 13:52