Capsule Endoscopy

The small intestine starts after the stomach and comprises the duodenum, the jejunum and the ileum. It measures close to 6m in length. Gastroscopy examines the oesophagus, stomach and first two parts of the duodenum, while colonoscopy examines the entire large bowel (colon) and up to 10cm of the terminal ileum. Capsule endoscopy examines the rest without the need for hospitalisation or sedation.

Capsule endoscopy uses a vitamin sized capsule which contains a tiny HD camera, batteries, LED light and transmitter. The capsule is swallowed with a sip of water and travels through the entire intestine taking multiple images per second. At some point in the following day or days the capsule is passed out and can be safely flushed away.

Capsule endoscopy is used to locate possible sources of bleeding within the small intestine when gastroscopy and colonoscopy have excluded blood loss from another location. Common indications include iron deficiency anaemia, unexplained melaena (black tarry motions due to altered blood) and obscure abdominal pain. The procedure can be used to exclude and to track small bowel tumours and to determine the severity of Crohn's disease of the small intestine when there is unexplained blood loss.

You should fast (no food or drinks) for 8 hours before undergoing capsule endoscopy. Diabetics should withhold their diabetic medication during the fasting period. If you take insulin, you may need to reduce the dose. Please discuss this with us. From 6pm the evening prior to the procedure you will be on a clear fluid diet with no solid food. Around 8pm you will take one sachet of picoprep to clean the small bowel. Strongly coloured foods and iron tablets should be avoided for 24 hours before the examination. Fasting is from midnight onwards.

On the day of the procedure, a harness, holding the data recorder, is worn for 8 hours after the capsule is swallowed. Gentle activity is encouraged while wearing the harness as this will aid the progress of the capsule. No fluids should be taken for 2 hours after the capsule is swallowed and solid food is not permitted to be eaten for 4 hours afterwards.

A glass of water is permitted when swallowing the capsule and a substance called 'simethicone' is added to this to prevent 'bubbles' which can interfere with the picture transmitted by the capsule. Just prior to swallowing the capsule you will also take a tablet of metaclopromide (maxolon/pramin) which helps the capsule to leave the stomach. Please let us know if you are allergic to this medication and it will be avoided.

Eight hours after the capsule is swallowed, you will return to have the belt removed. The information from the data recorder is downloaded onto a computer and the images are composed into a video to be examined by the doctor. The capsule is single use only and does not need to be retrieved. The capsule passes naturally in a stool within 1-3 days. Most patients are not aware it has passed. The capsule doesn't need to be retrieved and can be safely flushed down the toilet.

Capsule endoscopy is a very safe procedure and complications are very infrequent. Approximately 1 in 100 patients retain the capsule in the small bowel. This may occur if the bowel is narrowed or diseased or has some other unusual anatomy. Usually the capsule will eventually pass. On rare occasions it will need to be removed endoscopically or surgically. In most cases this is the site of an obstructing lesion which can be corrected at the same time. If bowel narrowing is suspected your doctor may suggest an initial trial with a dissolvable (Patency) capsule.

Rarely people are unable to swallow the capsule and it will need to be placed by a gastroscope. On the day of the test, approximately 1 in 10 patients may have a slow small bowel transit and the capsule may not be seen to reach the large bowel. An abdominal X-ray may then be arranged to check that the capsule has passed out of the bowel. You must not have an MRI scan until the capsule has passed from your body.