Capsule Colonoscopy

Not FDA Approved





What is Capsule Colonoscopy?



Capsule colonoscopy is a diagnostic procedure that allows a physician to "look" in the colon (also called the large intestine) without undergoing traditional colonoscopy. Capsule colonoscopy is a video capsule system, developed by Given Imaging Limited®. The capsule, which measures 11 x 31 mm, contains LEDs (light emitting diodes), two lenses, two color camera chips, two silver oxide batteries, a radio frequency transmitter, and an antenna. The camera is a CMOS (complementary metal oxide semiconductor) chip. This chip requires less power than present CCD (charged coupled device) chips found on video endoscopes and digital cameras, and it can operate at very low levels of illumination. The capsule obtains four images per second and transmits the data via a radio signal to a recording device. The recording device is the size of a "walkman" and it is carried by the patient on a shoulder strap. In addition to the images, the recording device calculates the exact location of each image, based on the signal strength of the capsule to its receiving skin sensors. Once the study is completed, the recording device is downloaded to a computer workstation whose software provides the images to a computer screen. The capsule is disposable and does not need to be retrieved. It is passed naturally in a bowel movement.



Why Capsule Colonoscopy?



The majority of Americans are not screened for colon cancer. Despite colon cancer being the second most common cancer killer and despite the fact that screening has been shown to save lives, most of us are not examined. Capsule colonoscopy allows for screening in a non-invasive manner. After cleaning the colon as one would do for standard colonoscopy, an individual simply swallows a pill with a camera in it. No sedation is needed. You can be active during the day of your exam.



What is the colon?



The colon, also called the large intestine, is a six-foot long organ that works to absorb water from the intestinal tract and help store and then deliver bowel movements. Ingested food first traverses the stomach where it is solubilized. Liquefied food then moves to the small intestine and this portion of the intestinal tract acts to absorb nutrients. Fluids then proceed to the colon where stool is solidified as water is absorbed. The beginning of the colon is located in the right lower portion of the abdomen. It comes up the right side and crosses the abdomen under the diaphragm and then drops down the left side of the abdomen into the pelvis and the rectum.



What is standard colonoscopy?



During colonoscopy, a flexible instrument is inserted into the rectum and is advanced throughout the colon. The patient is sedated for this exam that lasts an average of 30 minutes. The patient lies on their left side during the exam. The instrument has a video camera built into its tip and the image of the lining of the colon is projected on a television screen. The instrument is the diameter of an index finger. Dr. Lewis uses state-of-the-art equipment and presently uses high definition endoscopes. During colonoscopy, biopsies can be obtained from anything abnormal and polyps can be removed.



What are other examinations of the colon?



Another way to examine part of the colon is sigmoidoscopy. In this exam, a shorter instrument examines the bottom most portion of the colon called the sigmoid and that is how the exam got its name. This exam requires a less extensive preparation and patients are not usually sedated for the exam. This is no longer considered an appropriate test to screen for colon cancer.



Another exam is virtual colonoscopy. In this exam, the same preparation for standard colonoscopy and capsule colonoscopy is required. A patient has a small tube inserted in the rectum and gas is instilled to distend the colon. A CAT scan is then performed. The pictures obtained can be similar to pictures at colonoscopy though this test can miss small polyps. Polyps cannot be removed and if they are found, standard colonoscopy is required. The dose of radiation from a virtual colonoscopy is significant and this carries risk for cancer in the future.



What diseases can be detected by these techniques?



The colon is the site of the second most common cancer killer in America. The small intestine is an unusual site for cancer. Most colon cancer begins in benign growths called polyps. These bits of tissue can grow over years and then degenerate into cancer. Most polyps are easily removed during colonoscopy, thus reducing the future risk of cancer.



Other diseases that effect the colon include infections or chronic inflammatory illnesses that produce diarrhea, broken blood vessels that can cause bleeding, and diverticular disease that in a minority of patients can lead to pain, infection, or bleeding.



What preparation is required?



The preparation for capsule colonoscopy, standard colonoscopy, and virtual colonoscopy are all the same. The colon must be completely clean for the procedure to be accurate and complete. A liquid diet a day prior to the exam is required followed by an oral purgative that cleanses the colon. Enemas are not necessary. The office will provide you with detailed instructions for the preparation in separate literature. The preparation will vary according to your medical history and the timing of your exam.



What should I do about my current medications?



Most medications may be continued, but some medications can interfere with the preparation or the examination. You should notify the office of all medications that you take as well as any medication allergies you have.



Will they tell me what they found?



Yes. The recording device is downloaded to a workstation overnight. The procedure of reviewing the data can take an extended amount of time. You may contact the office 2-3 days following the exam to check the status of your report. A letter summarizing the exam will be sent to your physician. Should polyps be found during the exam, standard colonoscopy for the purpose of removing the polyps will be recommended.



When can I return to a normal diet?



You may return to your normal diet following passage of the capsule, unless you are given other instructions.



Will I notice anything different?



You will not be aware of the capsule inside your body.



What are the risks?



Having performed many colon capsule examinations, the potential for problems related to the procedure is distinctly uncommon. Capsule technology has been used since the 1950s. They were initially used to transmit information concerning acid production. John Glenn swallowed a capsule when he recently went into space. His capsule transmitted core temperature data. Capsules have been found to stay intact in the body and do not break open.



One commonly expressed concern is that the capsule will become caught somewhere inside. Capsule colonoscopy is contraindicated in patients with a history of bowel obstruction, bowel strictures, or fistulas. In these patients, the capsule can become lodged and surgery may be necessary to remove the capsule. In patients without symptoms of obstruction, e.g. without nausea, vomiting, and abdominal pain, the capsule risk that a capsule will be retained is quite low and the exam is considered extremely safe.



Capsule colonoscopy is contraindicated in patients with a pacemaker or implanted defibrillator.



The capsule is magnetic and thus patients should not go near a MRI during or after the procedure until the capsule passes from the body.



Capsule colonoscopy is an exam of the colon only. It does not examine the stomach or small intestine. Furthermore, due to variations in a patient's intestinal motility, the capsule may only image part of the colon. It is also possible that due to interference, some images may be lost and this may result in the need to repeat the capsule procedure.



Who invented the capsule endoscope?



The endoscopic capsule was the idea of Dr. Gavriel Idan. He is an expert in the field of photography and developed the idea while on sabbatical in a Boston hospital. The capsule is manufactured by Given Imaging Limited located in Yoqneam, Israel. Their website is www.givenimaging.com.



 
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