Camera capsule provides glimpse of small intestine

Of all the things to swallow, a camera might not be on top of anyone’s list — unless you’re a person suffering from a gastrointestinal problem that traditional tests have not been able to diagnose. For these people, the noninvasive capsule endoscopy offers hope for relief.

What makes the capsule endoscopy so exciting is that it provides visual access to an area that was not previously easy to see — the small intestine — and that means easier diagnosis of conditions such as ulcers, tumors and inflammatory bowel diseases such as Crohn’s disease, doctors say.

“There is 20 to 30 feet of small intestine. The traditional high definition scopes are very good to look at the esophagus and the stomach, and the colonoscopy looks at the colon, but it was difficult to look at the small intestine,” said Dr. Adnan Ahmad, a gastroenterologist with Jackson Siegelbaum Gastroenterology in Camp Hill. “Before, we relied on a barium X-ray, but it didn’t give you the detail that the video capsule gives.”

The capsule, which is the size of a large vitamin, contains a camera with a battery life of about eight hours — the time it takes for the capsule to travel through the digestive tract just like food does. During that time, it takes about two pictures per second, or about 50,000 to 60,000 images per eight hour study, said Sharon Malatestinic, clinical manager of the gastroenterology department at PinnacleHealth System.

The digital images are transmitted to a recorder that the patient wears as they go about their normal day. When the test is complete, the patient brings the recorder back so the images can be read by a doctor. “We don’t want the capsule back,” Malatestinic said. “It passes naturally in about eight hours.”

The most common use of the capsule endoscopy is to search for a bleeding source, Ahmad said. If the source can’t be found in the most common places — the stomach and the colon through use of an upper endoscopy and a colonoscopy — doctors can use the capsule endoscopy as a further diagnostic tool to view the small intestine.

The risks to its use are small, doctors say. However, in patients who have a small bowel obstruction, the capsule could get stuck and have to be surgically removed. Since the U.S. Food and Drug Administration approved the capsule endoscopy in 2001, its use has spread to hospitals and doctors’ offices around the country, including many in the midstate.

PinnacleHealth added the capsule endoscopy to its services at the Community Campus in Lower Paxton Twp. about eight months ago and it’s doing the job they wanted it to do, Malatestinic said. “The capsule provides easier detection of abnormalities so it makes it easier to diagnose abnormalities of the small bowel, tumors, and abnormal bleedings,” she said.

The capsule can also help doctors more definitively diagnose celiac disease, a digestive disease characterized by intolerance to gluten that blood work and other tests don’t readily show, Ahmad said. The capsule endoscopy can show subtle changes in the lining of the small intestine indicative of celiac disease, he said.

However, doctors can’t take biopsies with the capsule endoscopy procedure, so it was important to find a way to address the results that the video capsule discovered in the previously unseen territory of the small intestine, said Dr. Charles Dye, medical director of endoscopy at Penn State Milton S. Hershey Medical Center.

“A doctor in Japan invented a way to advance a scope deeper through the bowel by adapting an overtube for an endoscope, which is a more rigid device that you put the scope through in order to get it into the stomach and advance it further,” Dye said.

The balloons allow the scope to advance further, giving a visual examination of the small bowel that was only previously reachable through invasive surgery, he said. These revolutionary tools have greatly enhanced how well doctors can care for patients with small intestine issues, however, the key is how to treat them once found, Dye said.

“These tools improve the yield of potential findings, but they also pick up a lot of things that may or may not cause the patient problems, but because we see them, we feel compelled to do more testing that is more invasive and has the potential of injuring the bowel,” said Dye, who travels nationwide to teach doctors about the capsule endoscopy.

Still, for patients who before were frustrated by a lack of a definitive reason for their bleeding or pain, the capsule endoscopy provides not only answers, but often treatment and relief.

Though patients often wish otherwise, the capsule endoscopy is not a substitute for a colonoscopy. However, Ahmad said, research is being done for a video capsule for the colon that could be offered to certain people who are not good candidates for a traditional colonoscopy, such as those who cannot tolerate anesthesia.

Written by CAROLYN KIMMEL, for The Patriot-News.



Leave a Reply

You must be logged in to post a comment.