The 21 feet of small intestine situated a good distance between your stomach and colon has been notoriously hard to examine because of its location deep in the middle of the gastrointestinal tract. But the capsule endoscopy has changed that. With miniaturization technology and special batteries, we now have a tiny camera called a PillCam which is the size of a large gelcap that can be swallowed and then travel, by normal bowel contraction, all the way through the entire intestine, taking a movie for about eight hours of travel time. The capsule passes into the stool and does not need to be recovered.
Capsule endoscopy is the most sensitive way we currently have to examine the small bowel for causes of silent low grade bleeding, polyps, and patches of inflammation. Your doctor may need to exclude one of these possibilities based on your complaint, your physical exam or other lab or x-ray tests.
The exam may show abnormalities in the stomach and small intestine. These may include ulcers, erosions, silent bleeding areas, obscure polyps, and tumors. Even though we believe that capsule endoscopy is the most sensitive technique to examine the small bowel, it is by no means perfect. Possible lesions could be missed due to the preparation quality, the transient nature of some findings and technical problems. Despite aggressive research to improve PillCam evaluation of the colon, the colon is not very well seen by this exam and does not replace colonoscopy as the gold standard.
What preparation and diet should I have before the test?
What are the risks involved?
How long will it take to get a result back to me or my referring doctor?
Does it hurt to swallow and how big is the capsule?
How long does the exam take?
Do I have to take off work?
Your health status and current medications will be reviewed to choose the best possible preparation for you. When you have scheduled a date for the procedure, detailed preparation instructions will be given to you. If you forgot your “prep instructions,” verify with your doctor’s assistant the correct preparation instructions recommended for you.
In general, you will continue your usual medications except for a few specified in the instructions (which almost everyone can do without for several days). The day before the test, you will be asked to stay on a clear liquid diet starting after breakfast until 10 p.m., after which you will be asked to fast until you swallow the PillCam the following morning. Several hours after ingesting the camera you will be able to drink liquids and four hours later eat solid food. Remember there are specific instructions that go along with this general statement that you will be asked to follow to get the best examination possible for your specific problem.
The main risk of this technique is getting the camera stuck on a narrow area in the small bowel. Your doctor will often take special precautions to try to see if you have a stricture or narrow area in the small bowel before you use the PillCam. Even these precautions may not identify a subtle narrow area on x-ray studies. If the PillCam gets stuck and does not move, standard surgery may be required to relieve the obstruction and recover the PillCam.
There may be as many as 50,000 images for your doctor to review, so it will take him or her several hours to carefully review your study. This means it may take up to a week or more to get your results to you or your referring health care provider.
Capsule endoscopy is not uncomfortable. The pill is the size of a large vitamin gelcap.
The camera has a battery life of eight hours. If the camera does not progress all the way through the small bowel in eight hours, not all of the small bowel may be visualized and the exam may need to be repeated later.
Generally we recommend you not take time off from work other than to have your doctor’s appointment to place the receiver and begin the study by swallowing the camera. This way, you proceed with your normal activity which can make it easier to adhere to any dietary restrictions.