Small Bowel Capsule Endoscopy

What is capsule endoscopy?

Capsule endoscopy is a technology that uses a swallowed video capsule to take photographs of the inside of the esophagus, stomach, and small intestine. For capsule endoscopy, the intestines are first cleared of residual food and bacterial debris with the use of laxatives used before a colonoscopy. A large capsule is swallowed by the patient. The capsule contains a camera, a light source, a battery, and a radio transmitter. As the capsule travels through the esophagus, stomach, and small intestine, it takes two pictures a second for 8 hours. The photographs are transmitted by the radio transmitter to a small receiver that is worn on the waist of the patient who is undergoing the capsule endoscopy. The patient is free to move about during the 8 hour exam. At the end of the procedure, the photographs are downloaded from the receiver into a computer, and the images are later reviewed. The capsule is passed by the patient into the toilet and flushed away. It does not need to be retrieved.

What type of diseases can be diagnosed with capsule endoscopy?

Capsule endoscopy can help the doctor determine the cause for recurrent or persistent symptoms such as abdominal pain, diarrhea, bleeding or anemia. Some common examples of small intestine diseases diagnosed by capsule endoscopy include:

  • Crohn’s disease of the small intestine
  • Angiodysplasias (collections of small blood vessels located just beneath the inner intestinal lining that can bleed intermittently and cause anemia)
  • Small intestinal tumors such as lymphoma and small intestinal cancer

What are the limitations and complications of capsule endoscopy?

While the capsule provides the best means of viewing the inside of the small intestine, there are some inherent limitations and problems with its use, the most important of which is that the capsule does not allow for therapy. Other problems include:

  • Abnormalities in some areas of the intestine are missed because of rapid transit of the capsule and blurred, uninterpretable photographs.
  • At times, transit is slow and the capsule does not examine the entire small intestine before the battery dies.
  • If abnormalities are discovered that require surgical resection or further investigation, it may be difficult to determine exactly where in the small intestine the abnormality is located.
  • If there are narrow areas due to scarring (strictures) or tumors in the small intestine, the capsule can get stuck in the narrow area and cause an obstruction. This may require surgical removal of the capsule.

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