Many of us have recommended - and maybe even been the subject of - some of the most common gastroenterological endoscopic procedures, such as colonoscopy or upper GI endoscopy. Modern endoscopic techniques have revolutionized the diagnosis and treatment of diseases of the upper gastrointestinal tract (esophagus, stomach and duodenum) and the colon. The last remaining frontier has been the small intestine.
At about 20 feet long, the small intestine is the longest part of the human digestive system. It connects the stomach to the large intestine (or colon) and folds many times to fit inside the abdomen. The small intestine does most of the digesting of the foods consumed.
It also has been a difficult organ in which to make diagnoses and treat without performing surgery. Radiological procedures have been available for diagnosis, but they are time-consuming and not accurate in identifying small tumors and other subtle abnormalities of the small intestine.
“This part of the bowel cannot easily be reached by traditional endoscopy, which involves passing a long, flexible tube equipped with a video camera down the patient’s throat or through the rectum,” says Seema Dar, M.D., P.A., a gastroenterologist and founding member of Texas Institute Gastroenterology Associates (TIGA).
The search and study of improved diagnostic and therapeutic capabilities in the small intestine has been ongoing and fruitful. Enter wireless capsule endoscopy, or capsule endoscopy — one of the newest technologies that expand the diagnostic capabilities in the small intestine. Capsule endoscopy is not widely offered, but TIGA in San Antonio is one of the few clinics that make the highly effective procedure available to patients.
Capsule endoscopy provides gastroenterologists with images that cannot be captured with conventional X-ray technology. “This information can be critical in uncovering the causes of anemia due to intestinal loss of blood and diagnosing diseases that may involve only the small intestine, such as Crohn’s disease,” according to Dar. “The procedure is very simple and does not require any sedation or elaborate preparation like a traditional endoscopy or colonoscopy.
“Patients swallow the capsule with a sip of water in the office and can go about the normal course of a day’s activities until it is time to return the recorder.”
Dar explains how it works:
• A small data recorder is attached to the patient’s waist. The patient swallows a pill-shaped, vitamin-sized capsule containing a lighted camera that transmits video of the intestine. Along with the camera, the capsule also contains batteries, a light bulb and a radio transmitter.
• Over the next several hours, the camera travels through the patient’s digestive tract and takes thousands of pictures that are transmitted to the data recorder. During this time, the patient can continue normal activity, just being careful to avoid rigorous physical activity, such as running or jumping.
• After several hours (five to eight depending on the patient’s normal peristaltic time), the patient returns to the clinic, and the data recorder is removed.
• The information is downloaded from the recorder to a computer, and the images are viewed like a short movie. The capsule is disposable and is normally excreted naturally.
Dar uses the images transmitted by the capsule to diagnose and evaluate a variety of conditions, including:
• Anemia and gastrointestinal bleeding. Capsule endoscopy may help find the source of bleeding when other tests and procedures have not been conclusive.
• Celiac disease. Capsule endoscopy is sometimes used in diagnosing and monitoring Celiac disease.
• Crohn’s disease. Capsule endoscopy may reveal areas of inflammation in the small intestine that can help diagnose inflammatory bowel disease, such as Crohn’s disease.
• Intestinal cancer. Capsule endoscopy may show tumors in the small intestine.
• Polyps. Capsule endoscopy may show polyps in the small intestine, symptomatic of certain inherited syndromes.
Like X-rays, the capsule is purely diagnostic and cannot be used to take biopsies, apply therapy or mark abnormalities for surgery. Furthermore, this procedure does not allow specific exploration of any areas where signs of disease may be present.
Despite limitations, capsule endoscopy is frequently the test of choice for finding a source of small bowel bleeding if standard endoscopy has failed to do so. This groundbreaking technology is one more tool that gastroenterologists like Dar can use in the early detection of certain cancers and other life-affecting gastrointestinal disorders.
Capsule endoscopy continues to improve technically. It has revolutionized diagnosis by providing a sensitive (able-to-identify subtle abnormalities) and simple (non-invasive) means of examining the inside of the small intestine.
For more information about capsule endoscopy, call TIGA at 210-656-3715 (Northeast) or 210-268-0124 (North Central). You can also visit TIGA online at www.sagidoc.com.
