Wireless Capsule Endoscopy

1. Indications
   1. Obscure Gastrointestinal Bleeding
      1. Presumed Small Intestinal Bleeding
      2. Blood loss Anemia and normal standard endoscopy
   2. Non-bleeding indications
      1. Suspected Crohn's Disease
      2. Suspected Small Bowel tumor
      3. Abnormal imaging study of the Small Bowel
      4. Refractory Celiac Sprue
      5. Familial adenomatous polyposis syndrome
2. Contraindications
   1. Swallowing disorders
   2. Pacemaker or other implantable electromedical device
   3. Small Bowel Obstruction, strictures or fistulas
   4. Pregnancy
3. Technique
   1. Preparation
      1. Fast for 10 hours and no purging or
      2. Two liter PEG given 6 hours before capsule or
      3. Single dose of Simethicone before procedure
   2. Patient swallows disposable wireless video capsule
      1. Capsule is 2.6 x 1.1 cm in size (PillCam ESO)
      2. Capsule has 6-8 hour battery life
      3. Capsule contains microchip camera and light source
   3. Patient wears recorder
      1. Camera transmits 2 images per second to recorder
4. Complications
   1. Stool impaction
   2. Small Bowel stricture
   3. Retention of pill camera
5. Efficacy
   1. Overall, capsule misses 36% of lesions
      1. Appleyard (2000) Gastroenterology
   2. Identifies bleeding source in 55-76%
      1. Contrast with push endoscopy sensitivity: 21-38%
   3. Accurate in Crohn's Disease diagnosis
      1. Test Sensitivity: 89%
      2. Test Specificity: 100%
      3. Dubcenco (2005) GI Endoscopy
6. References
   1. Costamagna (2002) Gastroenterology 123:999-1005
   2. Ginsberg (2002) Gastrointest Endosc 56(5):621-4