Capsule endoscopy
The London Clinic has introduced a successful GI
capsule endoscopy service to the existing gastrointestinal
services. The first capsule endoscopy at The London Clinic was
performed in May 2006, and patient referrals continue to
increase. Capsule endoscopy allows clinicians to fully
investigate and treat patients with known or suspected
gastrointestinal disorders, particularly conditions that may affect
the small bowel.
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Description
Complete endoscopic examination of the small intestine has not
been possible until now. Capsule endoscopy provides excellent
visualisation of the entire small intestine using a pill-sized,
video imaging, wireless capsule that is swallowed by the patient.
Each capsule contains a camera, light-emitting diodes, batteries
and a transmitter.
During the procedure the patient can move freely around, and
over 50,000 colour images are recorded onto a data-recorder worn on
a belt around the patient’s waist. The capsule passes through the
small intestine as peristalsis occurs and is excreted naturally by
the patient.
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Each capsule contains:
- a camera
- light-emitting diodes
- batteries
- a radio-transmitter
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The Olympus
EndoCapsule
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Benefits of capsule endoscopy
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Capsule endoscopy has many benefits:
- the capsule is small and easily swallowed
- it is painless and sedation free
during the procedure
- the patient can relax in
comfort and walk about
- exposure to potentially harmful radiation does
not occur
- additional investigations can often be
avoided
- patients go home later the same
day
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Key findings of multiple clinical trials show that capsule
endoscopy is significantly superior for examination of the small
intestine for a broad range of indications compared to:
- small bowel enteroclysis
- barium follow-through
- CT and MRI
- push enteroscopy
- ileoscopy
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Capsule view of
small intestine |
Indications for capsule endoscopy
The main indications for capsule endoscopy include:
- iron deficiency anaemia when obscure gastrointestinal bleeding
is suspected
- diagnosis of early or suspected small bowel Crohn’s
disease
- detection of benign and malignant small intestinal tumours
(e.g. polyps, GISTs, lymphoma)
evaluation of Coeliac disease (not responding
to treatment or where there is doubt about
the diagnosis) and other other malabsorption
disorders that may lead to chronic diarrhoea
and weight loss
- identification of medication related to small bowel injury
(e.g. NSAID-induced enteropathy)
- an additional diagnostic facility for possible small bowel
abnormalities identified by other
investigations (such as CT, MRI or barium X-rays)
requiring further investigation
Investigations normally performed prior to capsule
endoscopy
Generally patients will have undergone a gastroscopy and
colonoscopy prior to capsule endoscopy, as many conditions commonly
affect the stomach and colon. If these prove unhelpful then a
capsule endoscopy may be considered.
Should the patient’s symptoms include significant abdominal
pain, distension and/or vomiting, it may be necessary to arrange a
Patency Capsule or a barium small bowel examination before capsule
endoscopy to exclude possible obstruction.
Contra-indications for capsule endoscopy
Capsule endoscopy is contra-indicated in patients:
- with known or suspected gastrointestinal obstruction,
strictures, or fistulas
- when swallowing disorders are present (although the capsule
can be placed endoscopically)
- during pregnancy
The capsule may be used in patients with cardiac pacemakers and
other implanted
electro-medical devices; however, temporary cardiac monitoring
may be required.
Side effects
Capsule endoscopy is a well-tolerated and safe procedure and
side effects are rare. To date, more than 400,000 examinations have
been performed worldwide. The main risk is capsule retention, which
is estimated to occur in fewer than 0.75% of cases. In the
rare instances when this occurs, an endoscopy or an operation may
be required to remove the capsule.
Should there be any doubts about using the capsule, a
biodegradable Patency Capsule (which dissolves away should it get
stuck) or a barium small bowel examination may be performed
first.
Preparing for capsule endoscopy
Capsule endoscopy is patient friendly and preparation usually
involves dietary modification only. Unlike conventional endoscopy,
no sedation or analgesia is necessary. Patients can
have a room at the Clinic reserved for their use during the
test, but are still able to go home later the same day.
Preparation for capsule endoscopy is simple:
- On the day before the procedure, lunch is followed by clear
fluids and then an overnight fast.
- The capsule is swallowed by the patient with some water in the
morning on the day of the
procedure.
- Fluids may be taken after two hours and a snack
after four hours.
- Patients taking iron tablets will need to stop these
for one week beforehand
The capsule endoscopy nurse will ensure that patients are fully
informed in advance of the procedure. Special arrangements
will be organised if patients are diabetic or have a cardiac
pacemaker.
Information written by Dr Chris Fraser, MB ChB
MD MRCP (Consultant Gastroenterologist and Specialist
Endoscopist)
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Our experts
Capsule Endoscopy Nurse
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See
our capsule endoscopy consultants
Michelle McCabe
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| Contact details
Telephone
Fax
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Endoscopy Unit
The London Clinic
20 Devonshire Place
London W1G 6BW
020 7616 7760
020 7616 7684
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General Disclaimer
This page is designed for educational purposes only and is not
engaged in rendering medical advice or professional services. The
information provided through these pagess should not be used for
diagnosing or treating a health problem or a disease. It is not a
substitute for professional care. If you have or suspect you may
have a health problem, you should consult your health care
provider.