The Wireless Capsule Endoscope (WCE) is a relatively new and little-used 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 lighted flexible tube with a camera on the tip used to examine the large intestine. Colonoscopy is recommended to detect colon cancer and the colon cancer precursor, colon polyps, as well as a diagnostic test to evaluate intestinal bleeding, diarrhea, or lower abdominal pain. The WCE is not yet technically feasible for the 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 larger and smaller diameter of the small intestine. Typical reasons for wanting to see 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 that 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 was long thought and taught that very few serious diseases occur in the small intestine (cancers or inflammation such as Crohn’s disease or celiac disease) that could not be diagnosed by upper or lower endoscopy or barium x-rays of the small intestine. As 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 and 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 a gluten-free diet or other warning signs such as weight loss, refractory anemia, blood loss, or abdominal pain in those who have not had the WCE can cause other serious small bowel problems, 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. Invariably it involves the small intestine and often only involves the small intestine. Sometimes the diagnosis cannot be made with a conventional colonoscopy and / or intestinal X-rays. The extent of small bowel involvement is also usually not accurately determined by radiography. WCE is becoming the diagnostic test of choice for Crohn’s disease, especially when combined with specific blood tests and a colonoscopy.
The capsule endoscopic procedure requires little preparation. Most doctors ask the patient to fast overnight before entering the clinic in the early morning. The patient has electrical recording cables connected to the skin of the abdomen that record the location of the capsule as it passes through the digestive tract. This helps the doctor to read the video recording with the interpretation of 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 the video recording from the pill chamber as it travels through the intestine.
The pill chamber is activated by removing it from a magnetized blister. It is swallowed with a glass of water. Typically, the patient is asked not to drink anything except water for 2 hours to allow the pill in the camera to have time to leave the stomach before being exposed to food or beverages that could disrupt 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 on the recorder so that the video can be downloaded to a computer for the physician to view.
Once activated, the battery in the small intestine pill chamber lasts for eight hours. Since the transit time from the mouth to the end of the small intestine in most people is around 2 to 6 hours, this is more than adequate for the entire small intestine to be videotaped. However, some people have delayed stomach emptying, slow bowel movements, or areas of blockage or constriction that prevent the pill chamber from reaching the end of the small intestine before the battery is depleted. When that happens, no more recordings are streamed. If the chamber pill becomes stuck, surgery may be required to remove it from the body. However, if this occurs, it is usually due to a condition in the small intestine for which surgery is the treatment of choice.
Recently, the FDA approved a pill camera that has the ability to record video images from both ends more quickly and is marketed as an alternative to standard upper endoscopy for examination of the esophagus. It is marketed as a very fast, painless and accurate method of detecting acid reflux, esophageal precancer and cancer, as well as varicose veins of the esophagus. Varicose veins are varicose-type veins that occur in the esophagus of people with cirrhosis of the liver that, if not treated with medications and / or rubber band ligation, can spontaneously bleed and be 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 biopsy abnormal-appearing tissue. However, the ease and speed of the test attracts people and will likely drive popularity as long as insurance companies agree to cover the test.
The WCE is being tested to examine the colon, but the larger diameter of the colon, the presence of stool, and the longer transit time are all 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 reproduces the movements of a beetle, effectively crawling through the intestinal tract, stopping and backing away under robotic remote control. The future looks promising and resembles The Fantastic Voyage 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.