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Abstract
“Camera Pill” or Capsule endoscopy, is a new diagnostic tool that permits a direct visual examination of the
small intestine, an area of the body not previously accessible using upper endoscopy from above or
colonoscopy from below. The pill, known as the M2A Capsule Endoscopy, is about the size of a multivitamin
and is swallowed with a sip of water. The pill is made of specially sealed biocompatible material that is
resistant to stomach acid and powerful digestive enzymes and thus every care is taken such that the caps will
not rupture or burst. Its non-invasive diagnostic alternative that is relatively quick, easy, office based test that
will encourage people to see their doctors to get checked for diseases"
Capsule endoscopy helps your doctor evaluate the small intestine. This part of the bowel cannot be reached by
traditional upper endoscopy or by colonoscopy. The most common reason for doing capsule endoscopy is to
search for a cause of bleeding from the small intestine. It may also be useful for detecting polyps,
inflammatory bowel disease (Crohn’s disease), ulcers, and tumors of the small intestine.
INTRODUCTION
The pill (developed at university of Washington)
consists of 7optical fibers,one for illumination and
the rest six for collecting light. once swallowed,
electric current flows through the pill that causes
the encased fibers to bounce back and forth such
that its electronic eye would be able to scan the GI
tract. The tip will iluminate red, green and blue
laser light helping in visuality, all this processing
together combined will give us two-dimensional
picture helping in diagnosis.The images can be
retrieved from the recording device worn around
patient's waist as a belt.(2)
All this is about the technical side, but how about
the patient compliance? at the end of the day,
'WE' are all here to make patient more
comfortable..Yup, the patient is comfortable and
convenient to swallow this large vitamin sized pill
that can be taken with a mouthful of water.
"Its non-invasive diagnostic alternative that is
relatively quick, easy, office based test that will
encourage people to see their doctors to get
checked for diseases" said by Dr. Michael Brown,
the gastroenterologist.
HISTORY:
Endoscopy means looking inside and typically
refers to looking inside the body for medical
reasons using an endoscope Unlike most other
medical imaging devices, endoscopes are inserted
directly into the organ. Endoscopy can also refer to
using a borescope
An endoscope is a flexible camera that travels into
the body's cavities to directly investigate the
digestive tract, colon or throat. These tools are
long, flexible cords about 9 mm wide, about the
width of a human fingernail. Because the cord is so
wide patients must be sedated during the scan. The
tiny camera is like swallowing a pill attached to a
string.
The camera's 1.4-mm-thick tether allows the doctor
to move the camera around and pull it back up once
the five- or 10-minute test is finished
An endoscope can consist of
A rigid or flexible tube
A light delivery system to illuminate the
organ or object under inspection. The light
source is normally outside the body and
the light is typically directed via an optical
fiber system
A lens system transmitting the image to
the viewer from the fiberscopean
additional channel to allow entry of
medical instruments or manipulators
CAPSULE ENDOSCOPY: The procedure, called
capsule endoscopy, has proven to be effective in
aiding diagnosis of previously undetectable
abnormalities in the small intestine that commonly
result in gastrointestinal bleeding
Capsule Endoscopy lets your doctor examine the
lining of the middle part of your gastrointestinal
tract, which includes the three portions of the small
intestine (duodenum, jejunum, ileum). Your doctor
will give you a pill sized video camera for you to
swallow. This camera has its own light source and
takes pictures of your small intestine as it passes
through. These pictures are sent to a small
recording device you have to wear on your body.
Your doctor will be able to view these pictures at a
later time and might be able to provide you with
useful information regarding your small intestine.
Capsule endoscopy helps your doctor evaluate the
small intestine. This part of the bowel cannot be
reached by traditional upper endoscopy or by
colonoscopy. The most common reason for doing
capsule endoscopy is to search for a cause of
bleeding from the small intestine. It may also be
useful for detecting polyps, inflammatory bowel
disease (Crohn’s disease), ulcers, and tumors of the
small intestine.
As is the case with most new diagnostic
procedures, not all insurance companies are
currently reimbursing for this procedure. You may
need to check with your own insurance company to
ensure that this is a covered benefit
Capsule enteroscopy allows your doctor to
visualise the small intestine which is often missed
by conventional imaging methods such as upper
gastrointestinal endoscopy or colonoscopy. The
most common reason for ordering this investigation
is to look for sources of bleeding. You may have
noticed blood in your vomit or faeces, or have
unnoticed blood loss that can cause iron deficiency
anaemia. This investigation can identify polyps,
inflammatory bowel disease (Crohn's disease or
ulcerative colitis), ulcers and tumours that may be
the source of the bleeding. Such lesions may not
have been found by previous investigations but
once identified, your doctor can decide an
appropriate course of management.
The other main use is for evaluating the extent of
Crohn's disease, which commonly affects the small
intestine. This investigation is particulary useful for
detecting early disease which may be missed by
barium examination and computed tomography
(CT). Also it can be useful in patients who have symptoms which do not match the extent of disease
(if any) seen by conventional imaging techniques.
Wireless capsule enteroscopy may have further
indications in the future as it is safe, easy to
perform, non-invasive and doesn't require sedation.
In particular, if techniques are invented that allow
treatments or biopsies (tissue sampling) to be
performed at the time of procedure, it will become
a very useful procedure.
It should be noted that this investigation may not
always be the best for you. The images taken by the
camera are of poorer quality than those obtained by
upper gastrointestinal endoscopy or colonoscopy.
In addition, the camera may move too fast or slow
to examine or the appropriate areas or be facing the
wrong way and miss some lesions. Thus, it is only
one possibility of a series of investigations you
may require in order for your doctor to make a
correct diagnosis.
PROCEDURE:
You will get a belt with a recorder to wear it
around your waist. You will swallow a camera that
will enter your bowel and take over 50,000 pictures
of the inside layer (mucosa) of your small intestine.
Pictures will be continuously sending via wireless
route (radio waves) to the recorder for 8 hours. You
will not be allowed to run or exercise during this
time but you will be able to freely walk around.
Two hours after swallowing the camera, you will
be allowed to start to drink and after four hours to
eat. When the camera will enter the large intestine
it will still take some time (12 to 72 hours but
usually within 24 hours after swallowing) to be
excreted with the stool. You will not need to return
a camera to the doctor.
No fluid is taken for at least 2 hours and no food
for a further 4 hours after swallowing the
capsule. Oral medications can be taken after 2
hours if required.
If you are diabetic, the medication must be stopped
during the fasting period and insulin use should be
discussed with your doctor
Capsule enteroscopy is a safe procedure and is well
tolerated by most patients. Less than 1 in 10 people
have difficulty swallowing the capsule, which has a
gel coating to help you swallow it.
The main risk is retention of the capsule, which
occurs in about 1 in a hundred people. The capsule becomes impeded by a stricture (narrowing)
secondary to a tumour, inflammation or scarring
from previous surgery. It is not dangerous in the
short term, but you may require a surgical
intervention to remove it. Obstruction may present
as bloating, vomiting or pain. You should consult
your doctor promptly if you experience these
symptoms. In most cases the capsule will pass
naturally from the body without any problems.