Capsule Endoscopy Procedure: A Personal Experience
My Mother's Experience With the Capsule Endoscopy Procedure
Several years ago, I became familiar with capsule endoscopy when my mother experienced a sudden drop in her hemoglobin, resulting in life-threatening anemia. In an attempt to diagnose what caused this, her doctors wanted to examine her small intestine more closely. One of the procedures that presented the least risk and discomfort for her was a capsule endoscopy or pill camera.
For the past three or four years, my mother struggled to maintain her weight as she found it difficult to eat more than a few bites of food at meal times. Earlier in the year, my mother underwent an EGD or esophagogastroduodenoscopy. The EGD examines the esophagus and stomach, while a traditional colonoscopy examines the large intestine. Both procedures use a flexible endoscope and fiber-optic camera to view examine the digestive tract.
Both procedures required sedation.
Although she had some diverticulum (pockets within the walls of her intestines) and a hiatal hernia, no other issues were revealed. Six months later, a sudden drop in her hemoglobin to life-threatening levels prompted her physicians to examine the only remaining portion of her digestive tract: the small intestine. To our relief, the test the doctor ordered was a capsule endoscopy.
What Is Capsule Endoscopy?
Patients swallow a "pill" which contains a tiny camera and light source. After being swallowed, this device will take approximately 55,000 images as it travels through the digestive tract. The images are wirelessly transferred to a small recorder that the patient wears strapped to their body via a velcro belt.
These pill cameras are designed to examine specific segments of the digestive tract, like the colon/large intestine, the esophagus, and in my mother's case, the small intestine. This allows doctors to examine about 25 feet of the digestive system that can't be viewed by traditional endoscopy.
Eight or nine hours after ingesting the pill camera, the recorder is returned, and the images are downloaded and reviewed by the physician to identify any issues.
What Does the Camera See?
Obviously, a pill camera can view the walls of the digestive tract. It can see any bleeding, tumors, areas that are narrowed, ulcerations, polyps, and so forth. It moves through the entire length of the digestive tract just as the food you eat does, via muscular constriction and relaxation or "peristalsis".
By doing this it can certainly help identify the source of any bleeding and assist in diagnosing cancer, Crohn's disease, discover ulcers, tumors, and so forth.
One thing the pill camera can not do that can occur during a typical endoscopic procedure is sample or remove tissue for biopsy.
The View From a Pill Camera
Preparing for a Capsule Endoscopy Procedure
Preparation for the test was minimal. My mother went on a liquid diet at noon on Tuesday and then stopped eating, drinking, and taking medications by early Wednesday morning.
We went to the outpatient clinic at 7:30 a.m. on Wednesday. We were there only 20 minutes. During that time, the nurse applied a few sensors to her body, strapped a light weight belt around her waist and attached a small recorder to it. She was then asked to swallow the pill camera which was the size of a large vitamin pill.
Once this was done, we were free to go. We were to check to make sure the recorder was still operating periodically by checking the light on it. After waiting a couple of hours, my mother was able to return to a normal diet.
No sedation was required and no laxatives were necessary to clear her intestines.
An Overview of the Procedure
The capsule endoscopy procedure was non-invasive and required less preparation than the EGD or colonoscopy which my mother had completed previously. Unlike these other tests, no anesthesia was required and in fact, aside from going into the outpatient clinic briefly in the early morning to be fitted with the recorder and swallow the pill camera, no hospital time was required. My mother was able to go about her normal routine with very little interruption.
In addition, preparation was minimal as well. With the colonoscopy, a complete clearing of the intestines via laxatives and massive amounts of clear liquids can be an intimidating prospect, but with capsule endoscopy, she only had to discontinue solid foods at noon the day before the test and forgo any medications a couple of hours before she was to swallow the pill camera.
Once the pill was swallowed, she had to wait only a few hours before she could have a meal.
Eight hours after swallowing the pill camera, we merely returned the recorder to the clinic and the pill passed in her stool sometime thereafter.
In addition to the ease and convenience of this test, certainly the cost was another benefit. Without time in the hospital, any anesthesia, and so forth, the total cost of the procedure was significantly less than for the typical colonoscopy. Insurance covered the cost, but even out of pocket I believe it was well under $600 (US).
Finally, of course is the clinical advantage that capsule endoscopy offers. While traditional endoscopes examine the upper and lower portions of the digestive tract, little else offers this first hand view of the small intestine in the middle.
While the pill camera offered a good way for the physician to view the small bowel, it did have some limitations. When completing traditional endoscopic examinations via a flexible endoscope, apparently physicians can biopsy any tissue they suspect as cancerous at the time of the examination. In fact, they can remove polyps as well during the procedure. These endoscopic exams can not only evaluate but allow the physician to intervene as well.
The same is apparently not true when using capsule endoscopy. The pill camera procedure is purely a visual diagnostic procedure. Additional, more invasive procedures would need to be conducted in order to sample or remove questionable tissue discovered by the camera.
In caring for my 83 year old mother, reducing the number of times she had to undergo sedation was a significant benefit.
Reviewing the images captured by the pill took little time. My mother and I received the results of her test within a day.
In my mother's case, nothing abnormal was seen and the source of her blood loss was later found to be related to some of her medication. By using the pill camera the gastroenterologist was able to view the small intestine, my mother didn't have to undergo drastic preparation, sedation, or any pain and discomfort.
A Few Other Considerations
More preparation might be necessary for the colon/large intestine or esophageal capsule endoscopy than what my mother experienced. This is something an individuals physician would have to determine.
The cost of any procedure will vary by provider and will of course change over time. Coverage will also vary based on the different insurance provider so before consenting to the procedure it is always best to check.
The only risk that I am aware of with the use of the pill camera is the chance of it becoming lodged somewhere in the digestive track. In this instance, if images from the camera itself couldn't confirm the location of the device an X-ray might be needed. Then depending on where it was stuck, either an endoscopy or surgery might be necessary to remove it if less invasive measures to get it to pass through the digestive tract were not successful.
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