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Wireless capsule endoscopy (WCE) is a relatively new and underutilized technology. It is underused due to limited insurance coverage for the test. Many people have heard of the so-called “camera pill” but don’t know when it can or should be done, or how it works. Many mistakenly believe that it could be a substitute for colonoscopy, a flexible tube with a light and a camera on the tip used to examine the large intestine. Colonoscopy is recommended to detect colon cancer and the precursor to colon cancer, colon polyps, as well as a diagnostic exam to assess for intestinal bleeding, diarrhea, or lower abdominal pain. WCE is not yet technically feasible for examination of the large or lower intestine known as the colon. Given Imaging was the first to develop this technology.
However, WCE is the only way to directly visualize the much longer and smaller diameter of the small intestine. Typical reasons for wanting to view the small intestine include unexplained intestinal bleeding, anemia (low blood count), suspected Crohn’s disease, known tumors or polyps. syndromes. Of the approximately 24 feet of small intestine a person has, only the top 1 1/2 to 3 feet can usually be reached and seen with an endoscope from the mouth and only the last few inches to a foot can be seen at the time of a colonoscopy exam through the rectum. It has long been thought and taught that very few serious diseases occur in the small intestine (cancer or inflammation such as Crohn’s disease or celiac disease) that cannot be diagnosed by upper or lower endoscopy or barium x-rays of the small intestine. Since WCE has started to be used more frequently, more diseases have been found than previously thought.
Celiac disease is a condition that affects the small intestine that can be associated with anemia, blood loss, lymphoma, and cancer of the small intestine. Higher-end tests usually make the diagnosis, but people with a poor response to the gluten-free diet or other warning signs, such as weight loss, refractory anemia, blood loss, or abdominal pain who haven’t had WCE, can harbor other serious problems of the small intestine, including lymphoma. and cancer
Crohn’s disease is a chronic inflammation of the intestinal tract that still has no cure and is of unknown cause. It invariably involves the small intestine and often only involves the small intestine. Sometimes the diagnosis cannot be made with conventional colonoscopy and/or intestinal radiographs. The extent of small bowel involvement is also usually not accurately determined by radiography. WCE is emerging as the diagnostic test of choice for Crohn’s disease, especially when combined with specific blood tests and a colonoscopy.
The capsule endoscopy procedure requires little preparation. Most doctors require that the patient fast overnight before coming into the clinic early in the morning. The patient has some electrical recording wires attached to the skin of the abdomen that record the location of the capsule as it passes through the digestive tract. This helps the doctor reading the video recording interpret where the pill chamber is and if it is lagging in an area. A video recording device is worn on a belt and wirelessly receives video recording from the pill’s camera as it travels through the intestine.
The pill’s chamber is activated when it is removed from a magnetized blister pack. It is swallowed with a glass of water. The patient is usually asked not to drink anything except water for 2 hours to give the camera pill time to leave the stomach before being exposed to food or drink that could affect the video recording. A light lunch is generally allowed after four hours. At the end of the day, the patient returns to the office to turn in the recorder so the video can be downloaded to a computer for the doctor to view.
Once activated, the Small Intestine Pill Camera battery lasts eight hours. Since the transit time from the mouth to the end of the small intestine in most people is around 2-6 hours, this is more than enough time to video the entire small intestine. However, some people experience delayed stomach emptying, slow intestinal transit, or areas of blockage or constriction that prevent the pill chamber from reaching the end of the small intestine before the battery runs out. When that happens, no more recordings are broadcast. If the chamber pill becomes stuck, surgery may be required to remove it from the body. However, if this occurs, it is usually because there is a condition in the small intestine for which surgery is the treatment of choice.
Recently, a pill camera that has the ability to record video images from both ends and more quickly has been approved by the FDA and marketed as an alternative to standard upper endoscopy for examination of the esophagus. It is marketed as a very quick, painless, and accurate method of screening for acid reflux, esophageal pre-cancer and cancer, as well as esophageal varices. Varicose veins are varicose-type veins that occur in the esophagus of people with liver cirrhosis that, if not treated with medications and/or rubber band ligation, can spontaneously bleed and become life-threatening. Insurance coverage for such an exam is limited. Other limitations include the ability to visualize only the esophagus, leaving the stomach and upper small intestine unexamined in detail, and the inability to biopsie abnormal-appearing tissue. However, the ease and speed of the test draws people in and will likely boost popularity as long as insurance companies agree to cover the test.
WCE is being tested for examination of the colon, but the larger diameter of the colon, the presence of stool, and the longer transit time are technical limitations that have delayed development. Several researchers, including a team from MIT, are working on a remote-controlled pill chamber with the ability to take tissue samples and deliver treatments. A researcher is trying to create a pill chamber that mimics the movements of a beetle, effectively crawling through the intestinal tract, stopping and reversing under robotic remote control. The future looks promising and resembles The fantastic journey through the human body. Until then, WCE is very useful and appropriate for the evaluation of certain gastrointestinal conditions and the signs and symptoms described above.