Yamuna D Karkera, an 81-year-old from Mumbai, had no specific chronic health problems. But she was alarmed when she started passing blood in her stools. Uncertain about her condition, her family took her to hospital, where she was advised to take a camera capsule endoscopy.
“My mother was initially advised to take a CT scan, an endoscopy and a colonoscopy to examine the condition,” says Pradeep, her son. “After it was suggested that she undergo a capsule endoscopy to detect the cause of the bloody stools.”
Yamuna thus became one of an increasing number of people in whose case doctors have used a novel diagnostic tool — capsule endoscopy or capsule camera — to understand the actual condition of the liver.
Dr Gajendra R, gastroenterologist, Aster RV Hospital, Bengaluru, says a small camera is inserted into a capsule, capturing photos of the small intestine. The photos are then transferred to a computer by a transmitter located in the patient’s waistband belt. “This technique is painless and safe,” he says.
Advantages of using a capsule camera
Over time, the capsule camera has undergone an evolution. “There are many types of capsules,” says Dr Gajendra. “Earlier, the photographs were recorded from the capsule and retrieved after the operation was complete. But now we use capsules that provide us with real-time images.”
According to Dr Subhash Agal, head of gastroenterology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, the relevance of the capsule camera is its ability to visualise the lining of the small intestine in detail. “The camera has a recording capacity of about 14 hours, after which the capsule is discharged rectally,” he says.
In Yamuna’s case, the capsule endoscopy diagnosis showed that she suffered from jejunal diverticulosis with diverticular bleeding, a rare condition of gastrointestinal bleeding.
“My mother did not feel any discomfort during the capsule endoscopy or after the examination,” says Pradeep. “The examination was quite successful.”
Dr Subhash says that capsule endoscopy has made it easier to identify small bowel diseases that conventional endoscopes do not reach. “The biggest advantage is that it is a non-invasive way of diagnosing bowel disorders,” he says. “However, the procedure is a diagnostic modality only, not therapeutic.”
When is camera capsule endoscopy needed?
“We only recommend a capsule camera endoscopy when the test results from an endoscopy or a colonoscopy come out negative,” says Dr Gajendra. “Only after detecting the problem from the results procured from the capsule endoscopy [is] the patient sent for further therapy.”
Agreeing with Dr Gajendra, Dr Subhash says, “This form of endoscopy is predominantly done to identify severe obscure gastrointestinal bleeding, iron deficiency anaemia and inflammatory bowel diseases.”
What is the procedure?
In Yamuna’s case, a capsule was inserted through her mouth. “The capsule endoscopy process lasted for about 20 minutes,” says Pradeep. “Later, I was called to view the live recording of the procedure.”
Elaborating on the steps that the patient must follow before capsule endoscopy, Dr Gajendra says, “Before attending the procedure, the person is required to go through bowel removal preparations. They will be prescribed laxatives eight hours before examination for the bowels to be removed and will be advised to undergo fasting.”
Explaining the procedure, Dr Gajendra says:
- The person is made to swallow the capsule, which will be present in the stomach for four hours before making its way to the small bowel.
- The capsule usually takes 16 to 18 hours to pass through the small bowel for a complete evaluation.
- Once this is done the patient wears a belt, and the doctor uses a transmitter to display images of the small and large intestines on a laptop.
- The capsule is later excreted through the feces.
“In addition, people on treatment are usually hospitalised because the progression of the capsule from the stomach to the small intestine must be controlled,” says Dr Gajendra. “If it doesn’t progress, we may need to remove it endoscopically.”
Who can undergo a capsule endoscopy?
Capsule endoscopy is prescribed for persons in the 14-60 age group.
Dr Subash emphasises that the process is not suitable for children since the capsule will be slightly larger for them.
Those undergoing the procedure generally don’t feel hesitant as they are constantly assured that this form of endoscopy is harmless, and is much like ingesting a capsule, says Dr Gajendra.
Possible risks, aftermath of capsule endoscopy
“One possible complication is that the capsule may get stuck if there is a luminal stricture [rigid thickening of the intestinal wall, causing obstruction],” says Dr Subhash. “Then it may require to be removed by enteroscopy [a procedure to examine the small intestine]. Therefore, the patient must undergo a CT enterography before undergoing capsule endoscopy to rule out any stricture in the small bowel.”
Takeaways
- Capsule endoscopy is an endoscopic, non-invasive procedure done under medical supervision.
- A person suspected to have any problem in the digestive tract or the small intestine is made to swallow a capsule that contains a small camera. The camera in the pill form obtains images of the small intestine lining. Eventually, the capsule is excreted from the body.
- This procedure is only recommended if further examination of the small intestine is needed, and it is regarded as harmless and painless.
