video capsule endoscopy (PillCam)

Indications

• small intestinal disorders
  • celiac disease or other malabsorption
  • Crohn's disease, (now gold standard)
  • small bowel tumors
  • chronic abdominal pain
  • small intestinal hemorrhage, obscure GI bleed
    • normal upper GI endoscopy & lower GI endoscopy
    • repeat gastrointestinal endoscopy recommended prior to capsule endoscopy
    • identified source of 15/20 acute upper GI hemorrhages with negative upper GI endoscopy
• esophageal disorders
  • Barrett's esophagus
  • esophagitis, GERD
  • esophageal varices
• gastroparesis

* FDA approved for small bowel examination

* as safe in elderly >= 80 years of age & with higher diagnostic yield than in adults 65-79 years of age

Contraindications

• intestinal stricture
• swallowing disorder
• cardiac pacemaker (esophagus)
• achalasia, Zenker's diverticula, gastroparesis
• psychiatric illness

* NOT approved for colon cancer screening

Advantages

• more sensitive for angiodysplasia, ulceration & intestinal tumors than contrast CT
• no sedation
• improves diagnostic yield for occult GI bleed

Disadvantages

• precise location of observed lesion is unclear
• does not improve outcomes

Procedure

outpatient procedure

• the patient swallows a small capsule
• the capsule contains a miniature camera that continuously photographs the gastrointestinal tract & transmits the images to a receiving unit worn by the patient
• 8 hours of recording
• 26 x 11 mm disposable capsule passed in the feces naturally, generally within 24 hours. Biodegradable capusles on the horizon.
• Videorecorder attached to patient, back & belt pack
• Patient may eat (liquids) after 4 hours.
• Data loaded into computer after
  • 8 hours (intestine)
  • 20 minutes (esophagus)

Sensitivity 90%, Specificity 95% (intestinal indications)

Complications

• surgery to remove capsule (rare)

Management

• push enteroscopy for upper GI bleed localized to the distal duodenum or proximal jejunum

Notes

Pillcam ESO for esophagus ($450)

Sensitivity insufficient for use in colon cancer screening.

Using traditional colonoscopy as the standard of comparison, capsule endoscopy had a sensitivity of:

• 64% for detecting polyps 6 mm or larger
• 73% for advanced adenomas 6 mm or larger
• 74% for cancers.
• sensitivities were higher with more thorough bowel preparation

More general terms

• capsule endoscopy