Capsule Endoscopy

(Wireless Endoscopy)
 Capsule Endoscopy
 What is Endoscopy?

• It is a visual examination of the upper intestinal tract using a lighted, flexible fiber optic or video endoscope.

 Reasons for the Exam

• Due to factors related to diet, environment and heredity, the upper GI tract is the site of numerous
disorders. These can develop into a variety of diseases and/or symptoms.

• Endoscopy helps in diagnosing and often in treating these conditions:

• ulcers
• Esophagitis and heartburn - chronic inflammation of the esophagus due to reflux of stomach acid and
digestive juices
• gastritis -- inflammation of the lining of the stomach

 Preparation
• It is important not to eat or drink anything for at least eight hours before the exam. The physician instructs
the patient about the use of regular medications, including blood thinners, before the exam.
Procedure

The throat is often anesthetized by a spray or liquid. Intravenous

sedation is usually given to relax the patient, deaden the gag reflex
and cause short-term amnesia. The endoscope is then gently inserted
into the upper esophagus.

The patient can breath easily throughout the exam. Other instruments
can be passed through the endoscope to perform additional procedures
if necessary. For example, a biopsy can be done in which a small tissue
specimen is obtained for microscopic analysis.

The exam takes from 15 to 30 minutes, after which the patient is

taken to the recovery area. There is no pain with the procedure and
patients seldom remember much about it.
Benefits

An upper GI endoscopy is performed primarily to identify and/or correct a

problem in the upper gastrointestinal tract.

This means the test enables a diagnosis to be made upon which specific
treatment can be given. If a bleeding site is identified, treatment can stop
the bleeding, or if a polyp is found, it can be removed without a major
operation.
• To diagnose and treat hidden GI bleeding
•To detect the cause for malabsorption
•To confirm problems of the small bowel seen on an x-ray
•During surgery, to locate and remove sores with little damage to healthy tissue
During the Procedure

•You will be placed on your left side and have a plastic mouthpiece placed
between your teeth to keep your mouth open and make it easier to pass the
tube.

•The doctor lubricates the endoscope, passes it through the mouthpiece, then
asks you to swallow it. The doctor guides the endoscope under direct
visualization through your stomach into the small intestine.

•Any saliva you have will be cleared using a small suction tube that is removed
quickly and easily after the test.

•The doctor inspects portions of the linings of your esophagus, stomach, and
the upper portion of your small intestine and then reinspects them as the
instrument is withdrawn.

•If necessary, biopsies and removal of foreign bodies and polyps may be
performed.

•The procedure usually is completed within 10-15 minutes. Any surgical

procedures will require several minutes, depending on the type.
Risks

•Upper GI endoscopy : Although rare, bleeding and puncture of your esophagus or

stomach walls are possible during EGD. Other complications include the following:

•Severe irregular heartbeat

•Pulmonary aspiration - When material, either particulate (food, foreign body)
or fluid (gastric contents, blood, or saliva), enters from your throat into your
windpipe
•Infections and fever
•Local pain
•Dehydration
•Cardiac arrhythmias
•Bleeding and infection
•Hole in your colon
 Capsule Endoscopy

Wireless Capsule Endoscopy is a term used to describe a miniature capsule used to record
images through the digestive tract for use in medicine. The capsule is a camera with the size
and shape of a pill used to visualize the gastrointestinal tract. The procedure was approved
by the U.S. Food and Drug

Capsule endoscopy is used as a less-invasive procedure in placement of a traditional

endoscope, which is a long, thin tube inserted into the rectum and transversed through the
colon or into the oral cavity.

At the present time, the capsule camera is primarily used to visualize the small intestine.

No available scope is able to traverse the entire length of the small intestine. Because the
capsule is swallowed and travels through the digestive system, capsule endoscopy takes a
longer amount of time than traditional endoscopy.

The images are of good quality, comparable to those from scopes. The test carries a high
sensitivity and specificity for detecting lesions. Early research has shown that capsule
endoscopy can detect evidence of disease in some cases that traditional endoscopy cannot.
What is capsule endoscopy?

Capsule endoscopy is a technology that uses a swallowed video capsule to take

photographs of the inside of the esophagus, stomach, and small intestine.

For capsule endoscopy, the intestines are first cleared of residual food and bacterial
debris with the use of laxatives and/or purges very similar to the laxatives and purges
used before colonoscopy.

A large capsule-larger than the largest pill-is swallowed by the patient. The capsule
contains one or two video chips (cameras), a light bulb, a battery, and a radio
transmitter.

As the capsule travels through the esophagus, stomach, and small intestine, it takes
photographs rapidly.

The photographs are transmitted by the radio transmitter to a small receiver that is
worn on the waist of the patient who is undergoing the capsule endoscopy.

At the end of the procedure, approximately 24 hours later, the photographs are
downloaded from the receiver into a computer, and the images are reviewed by a
physician. The capsule is passed by the patient into the toilet and flushed away
Capsule Endoscopy


capsule Electronics (1 - Optical dome; 2 - Lens holder; 3
– Lens; 4 – Illuminating LEDs; 5 – CMOS imager; 6 –
Battery; 7 – ASIC transmitter; 8 – Antenna).
 Capsule

Optical dome: Intestinal illumination by white light emitting diodes (LED’s)

Lens
Complementary metal-oxide silicone imager (color camera
chip)
Transmitter
Two batteries (silver oxide)

Features of the Capsule

Capsule takes two images per second

On average, 50,000 images are obtained during an 8 hour exam
Magnification: 8x
Capsule coating: non-adherant
Disposable
Why Perform Wireless Capsule Endoscopy for IBD?

Diagnosis
Differentiate UC from Crohn’s disease
Different natural history
Different medical and surgical therapies
Evaluate extent of small intestinal involvement
Determine disease
tipped villi - a sign of inflammatory or infiltrative change

“Q-tip” lesion
Day before procedure

•Normal breakfast and lunchtime meal then clear fluids until 10.00pm
•Nothing by mouth from 10.00pm until the start of the test

Day of test

•Arrive in the unit between 8.00am and 8.30am

•Admission and placement of sensor array and data recorder
•Capsule swallowed with small amount of water
•2 hours after ingestion of capsule clear fluids can be started
•A light snack may then be eaten approximately 4 hours after swallowing the capsule
8 hours after the swallowing the capsule a normal diet may be resumed
Performance

Overnight 12 hour fast

Sensors placed on patient
Patient wears a belt that contains a battery pack and data recorder.
Patient ingests capsule around 8am.
Patient may have clears two hours after ingestion.
Patient may have a light lunch 4 hours after ingestion.
Avoid other patients who ingested a capsule.
Patient returns 7-8 hours later.
Capsule is passed by the patient into the toilet and flushed away.
Average Transit Times

Stomach: One hour

Small Intestine: 4 hours

Capsule Passage: 2-3 days

Reading times can vary from 20 minutes to 2 hours

Inflammatory polyp Ileitis

Crohn’s disease Linear Erosions

 What are the limitations of capsule endoscopy?

While the capsule provides the best means of viewing the inside of the small
intestine, there are many inherent limitations and problems with its use, the most
important of which is that the capsule does not allow for therapy.

•Abnormalities in some areas of the intestine are missed because of rapid transit of
the capsule and blurred, uninterpretable photographs.

•At times, transit is so slow that the capsule examines only part of the small
intestine before the battery fails.

•If abnormalities are discovered that require surgical resection or further

investigation, it may be difficult to determine where in the small intestine the
abnormality is and thereby help direct therapy.

•If there are narrow areas due to scarring (strictures) or tumors in the small
intestine, the capsule can get stuck in the narrow area and cause an obstruction of
the intestine that requires surgical removal of the capsule.

•Finally, reviewing the tens of thousands of photographs is very time consuming for
the conscientious physician.