CAPSULE ENDOSCOPY OVERVIEW

Capsule endoscopy is an investigation that will enable me to visualize the entire length of the inside of the small bowel.

It consists of three components namely a camera the size of a large vitamin capsule, a sensor belt, which is strapped around the waist and a data recorder- a walk-man sized box that is connected to the sensor belt and carried around the neck.

Once the camera is activated and swallowed, it takes two pictures every second. The pictures are received by the sensor belt and stored in the data recorder.

The camera will travel through your small bowel and on average takes about 8 hours to reach your large bowel (colon).

After 8 hours the test is finished and I will remove the equipment so that I can retrieve the pictures that have been taken. The test generates up to 50 000 pictures!
The camera can only be used once and it will be eliminated with your next bowel action.

 

WHAT ARE THE RISKS WITH CAPSULE ENDOSCOPY?

Capsule endoscopy is painless and extremely safe. The only potential complication is capsule retention. This means that the capsule gets stuck in the bowel.

This risk is very low and happens on average in 1 out of every 100 people who do the test.
The risk is higher if you have had previous abdominal surgery or if you have symptoms that would suggest bowel obstruction.

The risk is also higher if you have Crohn’s disease.
In general, if the capsule gets stuck it means that there is a severe narrowing in the bowel, which will need an operation.

You should therefore not do a capsule endoscopy test if you are not prepared to have an operation if it is needed.

 

WHY DO I NEED CAPSULE ENDOSCOPY TO EXAMINE MY SMALL BOWEL?

The small bowel is between 3 and 8 meters long and only a very small portion of the small bowel can be examined during gastroscopy and colonoscopy.

Other tests such as CT and MRI are good to look at the outside of the bowel but capsule endoscopy is the best test to evaluate to the entire lining of the small bowel.

 

FOR WHICH DISEASES ARE CAPSULE ENDOSCOPY BENEFICIAL?

The commonest reason to do a capsule endoscopy is for obscure gastrointestinal bleeding.
If Crohn’s disease is strongly suspected but the colonoscopy and gastroscopy were normal.
For rare inherited conditions such as Peutz Jeghers syndrome.

 

WHAT IS OBSCURE GASTROINTESTINAL BLEEDING?

Obscure gastrointestinal bleeding means that an intestinal source of bleeding is suspected but that the gastroscopy and colonoscopy were normal.

The implication of this is that the bleeding source is in the small bowel.

Bleeding from the small bowel can either be visible (overt) ie vomiting blood or blood in the stool or it can be invisible.

It is not uncommon to lose large amounts of blood in the small bowel despite the bleeding being invisible (or occult).

In these cases, the blood loss will be suggested by the presence of iron deficiency anaemia (low blood count due to loss of blood and iron).

 

WHAT CAN WE FIND AT CAPSULE ENDOSCOPY?

There are 3 groups of abnormalities that can be detected with capsule endoscopy:

• Angio-ectasia- Abnormal blood vessels that are prone to bleeding.
• Ulcers- There are many causes of ulcers, the most common is the use of anti-inflammatory painkillers.
• Masses or growths- There are many different types and they can be either non-cancerous or cancerous.

 

CAN CAPSULE ENDOSCOPY TREAT THE CAUSE OF THE BLEEDING?

No, the capsule cannot take samples of the small bowel or deliver treatment.

Should an abnormality be found at capsule endoscopy, your doctor will discuss the management options with you.

 

CAPSULE ENDOSCOPY PREPARATION

Your small bowel needs to be clean before commencing the capsule endoscopy investigation.

Your bowel preparation the day before the capsule endoscopy consists of the following:

• You must be on a clear fluid diet for 24 hours before the procedure.
  As your test commences at 7:30 am, you should not have any solids after 7:30 am the previous day.
• You should have a normal breakfast before 7:30 am the day before the capsule endoscopy appointment.
• This should be followed by plenty of clear fluids taken during the rest of the day.
• Examples of clear fluids include Water, Energade or a similar alternative, clear juice (apple, grape), tea or coffee without milk (sugar is allowed), without any solids in or jelly (avoid red jelly). Clear, strained soup can be taken but no later than 1 pm.
• The afternoon before the procedure, between 4 pm and 8 pm, you should drink 1-litre Moviprep that has been prescribed.
• Please be fasting from 8 pm on the evening before your capsule endoscopy procedure – this means no medication, fluids or solids of any kind from 8 pm until I meet you the following morning.
• Take a second litre of Moviprep at 4 am the morning of the capsule endoscopy procedure, with plenty of water.

 

ON THE DAY OF THE PROCEDURE

Could we please meet at 7:30 am on the morning of your procedure. I will set the test up by connecting the sensor belt around your waist, which will be connected to the data recorder.

The test will commence once you swallow the video capsule. The setup will take approximately 20 minutes.

Thereafter you can go to work or home while the capsule travels through your intestines. As your intestines are more active while you move, it is advised to walk around as much as possible.

You can have a light lunch (sandwich or equivalent) and clear fluid to drink 4 hours after ingesting the camera.

You should meet me again at 3 pm so that we can stop the study and remove all the equipment.

 

AFTER THE PROCEDURE

You will be able to go home after the procedure. The capsule will get eliminated in your stool over the next 48 hours- I do not need it back.

It takes me on average two days to read all the images and generate a report.

I will email your referring doctor with the result and I will send you a copy.

 

WHAT IS THE COST AND HOW DO I GET AUTHORISATION FROM MY MEDICAL AID?

It is important to get authorisation from your medical aid as this is an expensive procedure and unless you obtain pre-authorisation they might refuse to pay and you will be liable for the account.

I would also advise that you enquire from them exactly how much they will cover as some medial aids either pay from your medical savings or only pay a certain percentage of the claimed amount.

You can contact us to confirm the estimated breakdown of the costs and all the codes you will need to obtain authorisation from your medical aid.

I would appreciate it if you could email or fax me the pre-authorisation number.

In some cases, your medical aid will require a motivation letter. Please contact me should this be required.