Capsule endoscopy: Advancements and insights

In his latest online article, Professor Owen Epstein gives us his insights into capsule endoscopy. He talks about what the procedure consists of, the potential limitations or contraindications, the preparation and what strategies or techniques can be employed to ensure optimal image quality and complete visualisation of the colon.

What do capsule endoscopy procedures consist of? How do they differ from traditional endoscopies?

Capsule endoscopy represents a groundbreaking innovation, enabling the visualisation of the entire 26-foot-long digestive tract without requiring any physical connections to the patient. Within this tiny capsule, a miniature TV studio is packed, transmitting a wireless video signal directly to a compact receiver device worn on a belt. To initiate the procedure, the patient simply swallows the capsule with a sip of water, and the capsule's natural passage through the bowels, from mouth to toilet, eliminates the need for any manual intervention. Almost the entirety of this painless process can be conducted at home. The wireless video recording is later downloaded onto a desktop computer and presented as a "movie," offering full control to the viewer. This approach eliminates the necessity for day case admissions, intravenous sedation, pain relief, or a post-procedure recovery period, making this safe and painless "drone" method a compelling alternative to traditional endoscopy. It raises the pertinent question: "Who truly requires a conventional endoscopy?

How does capsule colonoscopy compare to traditional endoscopy in terms of diagnostic accuracy and patient experience?

A number of published comparative studies have demonstrated that as a diagnostic device, capsule colonoscopy has similar accuracy to a colonoscopy.

What are the potential limitations or contraindications for performing capsule colonoscopy?

In contrast to conventional fiber-optic colonoscopy, the capsule endoscopy can identify abnormalities and lesions but lacks the capability to perform biopsies or physically remove these irregularities. However, it's essential to note that a significant proportion of individuals who undergo traditional colonoscopy do not have any abnormalities or have non-urgent, benign conditions that do not necessitate immediate intervention. In such cases, the capsule endoscopy serves as a preliminary assessment tool to determine whether any intervention is required and, if so, how urgently it should be conducted. It's important to highlight that capsule endoscopy is not suitable for patients with swallowing difficulties or those who have intestinal strictures.

Could you explain the preparation requirements for patients undergoing capsule colonoscopy?

The bowel cleansing for capsule colonoscopy is similar to that of traditional colonoscopy. This consists of a low fibre diet for a few days prior to the test, fluids only the day before the investigation and a bowel lavage solution taken is two split doses the night before and morning of the procedure. The only difference in preparation is the need to take a “booster” liquid after swallowing the capsule to ensure that the device can travel the entire length of the digestive tract with sufficient battery reserve. The booster is taken at home and accelerated the capsule though 20 feet of small intestine, ensuring it reaches the large intestine.

In which clinical scenarios would you consider using capsule colonoscopy as a first-line investigation for evaluating the colon?

It is feasible to identify a "low-risk" scenario where the likelihood of discovering a significant abnormality is minimal. Employing established criteria, a majority of patients who would typically be recommended for an urgent colonoscopy can avoid undergoing this invasive procedure. Typical candidates for this approach include individuals experiencing symptoms of irritable bowel syndrome (such as bloating, abdominal discomfort, and altered bowel habits) whose FIT test for fecal occult blood returns negative results, but both the patient and clinician desire reassurance. Moreover, individuals participating in colon cancer screening programes with a low-level stool FIT result (ranging from 10 to 100) exhibit a mere 1 in 20 chance of having a substantial benign polyp or cancer. Within this subgroup, 19 out of 20 patients could potentially be reassured and avoid the need for immediate intervention.

What strategies or techniques can be employed to ensure optimal image quality and complete visualisation of the colon during capsule colonoscopy?

The procedures for bowel cleansing and boosting play a pivotal role in ensuring a thorough and satisfactory video. The preparation process might appear a bit overwhelming, but there are multimedia materials accessible to guide patients through every stage. These resources are specifically crafted to empower patients to become proficient in the process. Furthermore, we offer a support desk for individuals who may have additional questions or concerns.

Professor Owen Epstein is a distinguished minimally invasive gastroenterologist with over 45 years of experience. You can schedule an appointment with Professor Epstein on his Top Doctors profile.