Samuel N. Marcus M.D., Ph.D.



PillCam Capsule Endoscopy

Have you seen a diagram of the small intestine lately? If not, take a peek at the one below and you’ll see why modern endoscopic procedures have had a difficult time getting a good look at the interior of the small intestine.

intestines diagram

It’s a long and winding road to say the least, which makes the small intestine more challenging to view via standard endoscopy technology. For decades, GI doctors wished there was a magic pill patients could swallow so we could see the interior of this vast organ (about 23 feet in total length!!).

PillCam Capsule Endoscopy Allows Visual Access to the Small Intestine

Now, with new PillCam Capsule endoscopy, our wish has been granted. PillCam offers several advantages like:

  • Being able to access regions of the GI tract that are difficult or impossible to access via endoscopy, as well as the esophagus, stomach and colon.
  • The ability for patients to participate in GI imaging without the need for sedation or invasive procedures
  • Detecting inflammation and/or digestive disorders more accurately.

What is the PillCam?

Capsule endoscopy uses a vitamin-sized pill containing video chips (these are one or two cameras inside, depending on the procedure), a light bulb, a battery and a transmitter. As the pill makes its way through your esophagus, stomach, small intestine and colon, it takes a continuous stream of pictures. These pictures are transmitted wirelessly to a receiver worn by you for the duration of the capsule’s journey – typically about eight hours.

Eventually, the capsule is passed, via your stool, and into the toilet. There is no need to retrieve it as it can be safely flushed away.

In the meantime, the images captured by the receiver will be downloaded in your doctor’s office for review. We use the information to detect digestive issues in the esophagus, stomach and small intestine. Although we will gain images of the colon, PillCam technology is not yet approved by the FDA for direct visualization of the colon mucosa.

pillcamWhat Will the Capsule Endoscopy Procedure Find?

There are all kinds of things we can see by reviewing the images provided during your capsule endoscopy. These include things like:

  • The cause of intestinal bleeding. If you have unexplained bleeding in your intestinal tract, often detected via blood in your school, imaging technology can help us detect the source so we can apply the best method of treatment.
  • Diagnosis of inflammatory diseases. Inflammatory diseases, like Crohn’s disease, used to be diagnosed via a process of exclusion. Now, technology like the capsule endoscopy allows us to make a more concrete assessment of chronic GI inflammation.
  • Cancer detection. Any tumors or potential cancerous lesions or growths in the GI tract may show up in the pictures. If so, we can go from there to schedule a biopsy and/or removal of the tissue in question if that seems necessary.
  • Celiac disease diagnosis. Because the pill is traveling via the same path as potentially offending gluten, we can use the PillCam to see how gluten affects your digestive tract, which can lead to more accurate diagnosis of celiac disease. It can also prevent the misdiagnosis of celiac disease, freeing us up to seek the true cause of existing digestive complaints or food sensitivities.
  • Polyp screening. Many studies have shown a link between polyps and eventual cancer growth. If you have a medical history of polyps or an inherited syndrome that causes polyps, we may choose to use capsule endoscopy to keep a better eye on things.
  • Get a second look. Sometimes, the results from a previous test or endoscopic procedure are “unclear” or “inconclusive.” Rather than scheduling another round of invasive endoscopy, we can use capsule endoscopy to get a more comfortable second look.

While capsule endoscopy doesn’t require sedation, it still requires the same cleansing preparations required for other endoscopic procedures – including fasts and purging.

The Limitations to Capsule Endoscopy

Due to the nature of the technology, there are some limitations of capsule endoscopy. Sometimes we aren’t able to see the images very clearly, depending on the speed the capsule is traveling when it takes the pictures. On the flip side, if the capsule moves more slowly than normal, the battery can run out at the 8-hour mark – leaving us with incomplete images. Also, we can’t always tell exactly where in the small intestine a particular issue lives, so that can make it difficult to locate if we need to perform more invasive or surgical procedures for treatment.

If the GI tract has obstructions and/or scar tissue (strictures), the capsule can potentially get stuck, requiring surgical removal. This is very rare, however. If we suspect you have strictures or obstructions that will limit capsule movement, we give you a dissolvable, dummy capsule first. If the dummy capsule gets stuck, we can locate it via X-ray and note the location of the stricture without any complications. It will dissolve and be absorbed by the body within a few days.

In the big picture, the continuing development of capsule endoscopy technology will continue to improve our ability to accurately diagnose and treat gastrointestinal disorders using the least invasive methods possible.

Contact Dr. Marcus’s office to learn more or to see whether you’re a good candidate for PillCam capsule endoscopy.