Can I still have an endoscopy during COVID-19?

Written in association with: Professor Owen Epstein
Published:
Edited by: Laura Burgess

During the coronavirus pandemic, some people will still need to see their gastroenterologist about serious health concerns that need to be diagnosed in relation to their bowels, such as Crohn’s disease, polyps or even bowel cancer detection.
 

Normally, your doctor would use a fibre-optic endoscopy to make a diagnosis but because the procedure is intrusive and creates aerosol particles, the risks of COVID-19 infection in endoscopy are high at this time
 

There is, however, an alternative procedure. Here one of our experts, Professor Owen Epstein, tells us about capsule endoscopy which requires no hospital admission and can be completed at home, which is essential during the coronavirus crisis.

Why is fibre-optic endoscopy problematic to carry out at the moment?

Upper and lower endoscopy are intrusive investigations, requiring day case admission, cannulation, sedation, continuous oxygen monitoring, and time to recover. Even under sedation, upper gastrointestinal endoscopy is accompanied by some retching and colonoscopy involves contact with lower bowel contents.


COVID-19 is transmitted by droplet spread and the virus has been identified in the stool for up to two weeks after a negative swab test. As normal service resumes, endoscopy is an intervention where great care will be required to safeguard both patients and endoscopy personnel.
 

Currently, because it is hard to know if patients are infectious with COVID-19, investigations or surgical interventions of any sort are only going ahead under life-threatening circumstances.
 

Why is a capsule endoscopy a safe solution?

Capsule endoscopy is a safer alternative. This is how:
 

  • Capsule endoscopy requires a glass of water to swallow the micro TV studio in a pill.
  • The capsule travels from mouth to toilet bowl, wirelessly transmitting a video of the bowel to a recording device.
  • There is no need for day-case admission.
  • The device is delivered in a COVID-19-free area of an outpatient setting.
  • The rules of social distancing are readily applied. There is no transmission-risk from body fluids.
  • During its journey through the oesophagus, stomach, small and large bowel, the video is wirelessly transmitted to a receiver worn on a belt.
  • There is no need to retrieve the capsule from the toilet.
     

At the Hadley Wood branch of the Royal Free, capsule endoscopy is available to investigate patients who would normally be considered candidates for the two-week cancer pathway or those particularly anxious about long delays for traditional fibre-optic investigation.
 

What would happen on the day?

You can expect the following:
 

  • Attend the outpatient setting.
  • Be fitted with the recorder belt and recording device.
  • Swallow the capsule with a sip of water.
  • Go home.
  • Return the device a number of hours later, as directed.

     

Professor Epstein is highly-experienced in treating indigestion, irritable bowel syndrome and digestive diseases. Do not hesitate to contact his clinic via his Top Doctor’s profile today if you would like his expert advice in your case.

By Professor Owen Epstein
Gastroenterology

Professor Owen Epstein is a renowned and pioneering professor of gastroenterology, based at the Royal Free Hospital in Hampstead, London. He has a special interest in the innovation of healthcare and the technologies used to ease the patient journey. These include whole bowel wireless capsule (pill) endoscopy and hydrogen or 13C breath testing variously for lactose intolerance, small intestinal bacterial overgrowth, Helicobacter pylori, stomach pump function and colon cancer screening using minimally invasive colon capsule endoscopy. He also has considerable experience in the physiological assessment of the vagus nerve and stress and, in particular, its relationship to abnormal gut feelings. Professor Epstein has had a hugely successful career and is regarded as one of the leaders in minimally-invasive techniques and a gentler patient journey.

Professor Epstein is widely published with more than 100 reviewed publications to his name. He is the senior author of the best-selling textbook Clinical Examination and the originator of the 'The Map  of Medicine', which is a key online resource used by healthcare professionals. He founded the Royal Free Screen Based Simulation Centre, where medical and surgical gastroenterologists use virtual reality to acquire mastery of endoscopy and laparoscopic surgery prior to engaging in live procedures. More recently, Professor Epstein has introduced new and minimally-invasive assessment tools and founded a new 'Institute for Minimally Invasive Gastroenterology (IMIGe)' at the Royal Free. He is director of the IMIGe Academy for Capsule Endoscopy which teaches aspiring capsule practitioners. Professor Epstein is award-winning and, over the years, has received research grants amounting to more than £1 million. He has contributed hugely to new medical technologies that change the patient's journey, and continues to do so.

Professor Epstein works out of the Royal Free PPU where he currently runs one of the UK’s leading PP colon capsule units. Professor Epstein is currently the lead clinician on the advisory panel of the new NHS England Colon capsule endoscopy colon cancer screening pilot (50000 patients)

He has also developed the capsule endoscopy curriculum(small and large intestine)  for teaching novice NHS England gastroenterologists how to read and report capsule endoscopy. He has mentored over 400 UK gastroenterologist as well as aspiring capsule readers in Europe, Hong Kong, West Africa and the Amercias.s.Professor Epstein is a regular invited speaker to  major international conferences on capsule endoscopy.

Over the past few years, Professor Epstein and his team have developed a unique investigation unit to monitor vagus nerve function in patients with IBS, functional dyspepsia and other  "functional disorders". This is based on a wearable device that continuously measures heart rate variability over 3 days to establish whether or not the there is a "software" disorder underlying unexplained or gastroenterology drug unresponsive disorders. He has considerable experience of offering  non invasive vagus nerve stimulation to appropriate patients with abnormal vagus nerve function (using gammaCore).

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