Capsule Endoscopy Update
Slightly over a year ago, Dr. Swafford spoke at our Feb 2004 meeting to describe Capsule Endoscopy, the technique where a patient swallows a capsule containing a miniaturized camera (with its own light source, radio transmitter and battery) which has proven to be a major advance in diagnosing problems in the small intestine. Now at our April 2005 meeting, Terrie Wright, the endoscopy nurse at Stillwater Medical Center, updated us on more recent experience and presented a computerized slide show provided by Given Imaging, the company that makes the capsule.
We learned that Given’s capsule, which they originally sold with the name M2A™ (“mouth to anus”), has been renamed the PillCam™ SB (for “small bowel”), as they now also have a version called the PillCam™ ESO for imaging the esophagus. The original SB capsule has a camera at one end and takes 2 pictures per second which are recorded for a total of 8 hours. The ESO capsule has cameras at both ends and takes 14 pictures per second which are recorded for only about 5 minutes. Of course, the esophagus can also be imaged by more conventional endoscopy, but patients may prefer the capsule method, as it avoids discomfort and doesn’t require sedation.
We also learned that capsule endoscopy has been approved for pediatric use (in children aged 10 or over). Given now sells a pediatric accessory kit for this purpose with a recorder belt and sensor array more appropriately sized for children. (The capsule itself is the same type used by adults.)
Given has also made improvements in their data recorder and the software used by the physician for interpreting/reviewing the recorded images. These include better ability to determine the locations where images are recorded and automatic highlighting by the software of possible pathologies in the images.
Terrie told us that, so far, the capsule technique has been used more in Europe than in the United States, but it is gradually becoming available at more U.S. locations.
Following last year’s presentation by Dr. Swafford, I was somewhat concerned whether ileostomates could easily excrete the capsule following examination, or if it might get stuck behind the stoma in the same way that ileostomates may get food blockages. In practice, this doesn’t seem to have been much of a problem. Any possible stricture or narrowing in the intestine does need to be considered, as the capsule could possibly get lodged and need to be removed surgically. But the risks must always be weighed against expected benefits of the procedure.
Our own member, Ruby, who underwent this procedure, is an ileostomate. Ruby was suffering from severe blockage due to stenosis (narrowing) of part of her intestine. She clearly needed surgery to remove the stenotic region. It was judged that the extra diagnostic information provided by capsule endoscopy could be very helpful, while the risk of the capsule getting stuck was unimportant, considering that she was going to have surgery in any case. As it happened, the capsule didn’t get stuck. It took about a day and a half to get past the narrowed region of intestine, but then had no difficulty passing out through her stoma.
Note: Ruby has now had the surgery to remove the stenotic portion of intestine and is doing fine.
According to Given’s literature, the capsule procedure is contraindicated under the following conditions:
While the capsule is inside the patient’s body, it is important to avoid exposure to strong electromagnetic fields such as created by MRI devices. The capsule includes magnetic materials and, if exposed to strong fields, may undergo violent motion, possibly causing serious damage to the intestinal tract or abdominal cavity.
For more information, see Given’s website at www.givenimaging.com.
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Content last revised 2005-05-02