Process Description: Capsule Endoscopy

Kevin Bobeck English 202C

Audience and Scope of Discussion

The purpose of this document is to provide a basic understanding of how capsule endoscopy works. This document will concentrate on the endoscope pill camera as well as give an overview of the process. Furthermore, the document will describe the possible complications and the advantages and disadvantages of this procedure. Once the reader has finished reading the document, he should be able to identify the main parts of the endoscope pill camera and have a basic understanding of the process. The audience for this document would most likely be any medical or pre medical student interested in specializing in gastroenterology or someone who is about to undergo this procedure. This could be used in a pamphlet that could be given out to a patient who is about to undergo such a procedure. This document could be beneficial because it could better explain the process to the patient.

Introduction to Capsule Endoscopy

Capsule endoscopy is a process that allows a physician to examine a patients gastrointestinal tract (GI); specifically, the inner lining of the small intestine, which is divided into three parts: the duodenum, jejunum, and ileum. The patient swallows a pill with a color video camera inside that will works its way through the GI and can take up to 50,000 images of the lining of the small and large intestine. The pill takes about 8 hours to work its way through the patients system. The purpose is to detect if the patient has any diseases or intestinal bleeding in their GI tract. The diseases that can be detected through this procedure include Crohns Disease, peptic ulcers, polyps, Celiac disease, and intestinal cancer. This procedure is mainly used to examine the jejunum and ileum because these are the sections of the gastrointestinal tract that traditional endoscopes cannot reach. These regions of the GI tract can be seen in Figure 1.Esophagogastroduodenoscopy has an endoscope that is inserted through the mouth and examines the esophagus, stomach, and duodenum but cannot reach the jejunum. Colonoscopy uses an endoscope that is inserted through the anus and examines the colon and large intestine but cannot reach the ileum; thus illustrating the importance of capsule endoscopy.

Figure 1. The Gastrointestinal Tract

The Endoscope Capsule

The size of the endoscope capsule is 25 mm by 11mm, about the size of a large vitamin pill, and weighs about 4 grams. The capsule is made of a specially sealed biocompatible material that is resistant to stomach acid and powerful digestive enzymes. The capsule contains a color video camera, an antenna, 4 LED lights, and a battery. These devices are illustrated in Figure 2 seen below:

Figure 2. The Endoscopy Capsule

The 4 LED lights provide illumination of the digestive tract or otherwise the images would be too dark to detect anything. The camera can take up to 50,000 images of the GI tract. The battery is used to power up the camera and the LED lights. The antenna allows for the images to be sent wirelessly to a recorder that is attached to the patients belt.

How to Prepare
Before the actual procedure can take place, the patient must undergo strict preparation in order for the procedure to provide the most accurate results. Here is a list of some general preparations that the patients physician may or may not require: Stop eating 12 hours prior to capsule endoscopy procedure. This will ensure that there is no food in the patients system that may make the images unclear or slow the passage of the pill through the digestive system. Laxative Preparation. The patients physician may require them to take a laxative in order to flush out the small intestines. Studies have shown that patients that use laxative preparation have the most accurate results. Stop taking medications. The patient should take their medications 2 hours prior to capsule endoscopy so that the medication does not get in the way of the camera. Plan to make it an easy day. In most cases, the patient will be able to able to go about their day in a normal fashion. However, the patient will most likely be unable to engage in any strenuous activity because it may disrupt the functionality of the capsule.

These are only general preparations. The physician may require even more preparations or only a few of these. The most important thing is to listen to the physicians specific instructions. Failure to observe the necessary preparations may result in the rescheduling of the procedure.

The Procedure
On the day of the procedure, the patient will meet with the physician in the physicians office. The patient will be asked to remove his shirt so that adhesive patches can be attached to the abdomen. A recorder will be firmly attached to the patients waist area with a secure belt. The patches contain antennae that will receive images from the capsule as it passes through the GI tract. The antennae will then relay the images to the recorder, which will collect and store the images. Once everything has been fixed securely in place, the physician will hand the patient the endoscopy capsule along with a glass of water. The capsule will be covered in a slippery layer that will make it easier to swallow. The patient may feel the capsule pass through their throat but once it reaches the esophagus, it will no longer be noticeable. The physician will then discuss any restrictions such as avoiding strenuous activity, but otherwise the patient is free to leave and go about their day.

After the Procedure

The patient may begin to drink water or other fluids 2 hours after ingestion of the capsule and after 4 hours, the patient may have a light snack. The capsule is far enough through the patients system by then that the food will have no effect on the pictures. The capsule endoscopy will end after 8 hours or when the patient notices the pill in the toilet after a bowel movement, whichever comes first. The patient can then remove the adhesive patches and the recorder and pack them away as told by the physician. There is no need to collect the capsule because it can be harmlessly flushed down the toilet. The patient should not be alarmed if they do not see the pill in the toilet after a few days because each persons digestive system is different. However, if the pill is not visible after two weeks, the patient should contact their physician for an X ray to determine if the capsule is still in the body.

Results
Once the patient has returned the equipment, the physician removes the SD card of the recorder and places it into a computer. This computer contains software that allows it to generate a video of the GI tract from the thousands of still images that were taken by the camera in the capsule. The physician will then watch the video and try to detect any abnormalities that the patient may have in their GI tract. This process may take a few days or even up to a week; however, the physician will meet with the patient soon to discuss the results. Figure 3 is an example of the type of image the physician will see in a healthy intestine. Figure 4 is an example of the type of image that a physician would see in a patient with intestinal lesions.

Figure 3. Healthy Intestine

Figure 4. Intestinal Lesions

Risks
This is a very safe procedure that has very few risks. In rare cases, the capsule can become lodged in the patients GI tract. The capsule can then be removed by surgery or by inserting a tube in the mouth or anus to retrieve the pill. According to the Mayo Clinic, only 1% of patients who undergo this procedure have this side effect. This percentage may be higher among those persons who have Crohns Disease.

Conclusion
Capsule Endoscopy is a very beneficial procedure with small risk. This procedure is much more comfortable than other types of endoscopy because it is essentially non invasive. It is also a rather inexpensive procedure and is frequently covered by the patients insurance. However, capsule endoscopy provides less sensitivity in detecting polyps and lesions in the intestine; therefore, it should never be used as a substitute to an esophagogastroduodenoscopy or a colonoscopy. As technology improves and as more advanced endoscopy capsules are invented the accuracy of this procedure will improve and may one day replace esophagogastroduodenoscopies and colonoscopies.

References
Figure 1 (unmodified): "Wireless Capsule Endoscopy: "The Camera in a Pill"." GI Health. N.p., n.d. Web. 1 Mar. 2012. <http://www.gihealth.com/html/test/given.html>. Figure 2 (unmodified): Mayo Clinic. Mayo Foundation for Medical Education and Resear, 17 July 2010. Web. 1 Mar. 2012. <http://www.mayoclinic.com/health/medical/IM04443>. Figure 3 (unmodified): Pezzoli, Alessandro, Nadia Fusetti, Loredana Simone, Angelo Zelante, and Viviana Cifala. "Portal Hypertensive Enteropathy Found by Capsule Endoscopy : Case Presentation." MedScape . Web. 13 Mar. 2012. <http://www.medscape.com/viewarticle/740797_2>. Figure 4 (unmodified): Shi, Bin, Yiping Wang, Yuexiang Chen, Weizhong Chen, and Weifen Xei. "Treatment of chronic bleeding of the small intestine in Rendu-Osler-Weber disease with argon plasma coagulation under double-balloon enteroscopy." BMJ 26 Feb. (2009). Web. 12 Mar. 2012. <http://casereports.bmj.com/content/2009/bcr.08.2008.0664/F1.large.jpg>. Mayo Clinic. Capsule Endoscopy. Mayo Foundation for Education and Research, 17 July 2010. Web. 1 Mar. 2012. <http://www.mayoclinic.com/health/capsule-endoscopy/MY00139>. Fiore, Kristina. "Camera Pill Not as Good as Colonoscopy." MedPage Today. Ed. Zalman S. Agus. Everyday Health, Inc., 15 July 2009. Web. 1 Mar. 2012. <http://www.medpagetoday.com/Gastroenterology/GeneralGastroenterology/15106>.