Capsule Video-Endoscopy

Capsule video-endoscopy procedure is the most exciting development in gastroenterology in recent years. The stomach can be examined by a gastroscope and the colon by a colonoscope. In between these organs, at the top and bottom of the gastrointestinal tract is the small bowel. This is a 3-metre section which is responsible for absorbing all the liquid and foods you ingest.

There is a specialised small bowel endoscope, a double-balloon endoscope, which can pass through the small bowel. This is done either through the stomach or colon. It is a difficult and time-consuming procedure but one which also enables specimens to be taken for examination.

A capsule video-endoscope is a specialised camera that's the size of a large medicine capsule. The endoscope takes about 3 pictures a second for 11 hours. These pictures are radioed to a receiver that the patient has around the waist for the duration of the test. Capsule video-endoscopy is normally indicated to:

    • Find the cause of gastrointestinal bleeding
    • Diagnose inflammatory bowel diseases (IBD)
    • Diagnose obscure causes of diarrhoea or abdominal cramps
    • Diagnose cancer
    • Diagnose coeliac disease
    • Screen for polyps
    • Do follow-up testing when imaging tests are unclear or inconclusive

The test is totally painless but needs to be done on a completely empty stomach. Capsule video-endoscopy requires the most stringent avoidance of any fluid or liquid for 10 hours before the procedure. On arrival in the rooms, half a litre of “KleanPrep” is drunk to wash out the stomach and provide a mini-tsunami to clear the small bowel of debris.

During the procedure, a recorder is placed around your waist to record the pictures that the capsule produces. We then give the patient the capsule to swallow with water. After swallowing, the patient can go about their day. The patient returns to the rooms 10 hours later for removal of the waist recorder. The capsule is passed out in the toilet in the normal way.

The only problem with a video capsule study is the danger of having a narrowing in the bowel, which might hold the capsule back. Fortunately, this has only been a problem in one of approximately 800 patients, where the capsule spent a year inside the patient without causing any harm. It was removed during an incidental abdominal operation and looked as good as when it was swallowed the previous year. On a serious note, we try and avoid this from happening. Usually, if there is a narrowing, it needs to be treated either medically or sometimes surgically when it can be retrieved.

The final problem is the cost of the capsule. It is very expensive, but it is a wonderful tool, and most medical aids will fund it if Dr Wright motivates strongly enough. With the correct indications, there is really no alternative to the capsule video-endoscopy.