Capsule Endoscopy (Pillcam)

Capsule endoscopy or pillcam is a procedure designed to help the doctor see what is happening in the gastrointestinal (GI) tract.  It is the least invasive and most direct way to see the small intestine which is otherwise unreachable via endoscopy.  The MacMurray Centre does the most capsule endoscopy in New Zealand and are the leaders in this field.
A capsule endoscopy involves swallowing a small capsule (the size of a large vitamin tablet) with a tiny video camera inside.  The capsule moves painlessly through your digestive tract by the body’s own natural peristalsis, whilst taking pictures of your intestine.  The images are transmitted to a sensor belt, which is worn around your waist and attached to a data recorder.  The data recorder will save all the images.  After about 12 hours the data recorder and sensor belt will be taken off for processing. You will eventually pass the capsule in a bowel motion.

What is the preparation for a Capsule Endoscopy?

Stop iron tablets five days before your test unless advised otherwise by your gastroenterologist.
Your stomach and small bowel must be flushed free of waste to give the clearest view possible.  Your specialist will instruct you if you need to take a medication called Glycoprep to flush out your bowel (Preparation 1) or if you can prepare without (Preparation 2). See instructions below.

Preparation 1 (With Glycoprep)
Day before examination

Feelings of bloating or nausea may occur after the first few glasses of Glycoprep. Slowing the rate of drinking can decrease nausea.  Drink unsweetened clear drinks during and after drinking Glycoprep to prevent dehydration.  These can be warmed if you are feeling cold.

Preparation 2 (Without Glycoprep)
Day before examination

Clear Fluids

• Water, tea and coffee without milk.
• Lemon flavoured energy drinks, colourless cordials and carbonated drinks. No highly coloured drinks.
• Strained fruit juice, some soups (e.g. strained chicken noodle).
• Lemon ice blocks, light coloured jellies, barley sugars, boiled sweets.

Important medications may be taken up to two hours before your appointment time with a mouthful of water.
If you suffer from angina or asthma please bring your GTN spray or inhalers with you.  If you are an insulin dependent diabetic, please bring your insulin with you.

How is a Capsule Endoscopy performed?

A sensor belt will be fitted around your waist and will be connected to the data recorder.  You will then swallow the capsule.  The capsule endoscopy will last 12 hours during which time you will leave the MacMurray Centre.  You can go home or go to work.
After swallowing the capsule, do not eat or drink anything for two hours. After two hours you may drink clear fluids. After four hours you may have a light lunch.
After swallowing the capsule and until it is excreted, you should not go near any source of powerful electromagnetic field such as an MRI (Magnetic Scanner) device at a hospital.
Avoid any strenuous physical activity but make sure you keep active.  Do not lie down or go to sleep.  The more you move, the more active your bowel is and the capsule will progress further through your bowel.  Avoid bending or stooping during the capsule endoscopy as this may cause the sensor belt to loosen.  Do not remove the sensor belt at any time during this period.
The data recorder holds the images of your examination.  Handle this data recorder and the sensor belt carefully.  Do not expose them to liquids, shock, vibration or direct sunlight, which may result in loss of information.

What happens after a Capsule Endoscopy?

Remove the data recorder and sensor belt after 12 hours and return to the MacMurray Centre.  The capsule is disposable and it will be excreted naturally in your bowel movement.  You may not notice it passing.  If you develop unexplained post-procedure abdominal pain or vomiting (which may indicate a bowel obstruction), please contact your GP or the MacMurray Centre.
The results of the wireless capsule endoscopy may take up to one week to review carefully.  The results will be communicated directly to the doctor who referred you for the test.  Any further discussions about the results should be directed to your usual doctor.

Safety and Risks

Since the first video capsule was approved by the FDA in 2001, more than 700,000 patients have safely swallowed one of the video capsules.
There is a very small risk that the capsule could get stuck in a previously unsuspected stricture or narrowing and cause an obstruction of the bowel.  This is extremely unlikely to occur as most people coming forward for wireless capsule endoscopy have already undergone numerous standard bowel investigations, which would show up any such strictures within the bowel.
You should not have a capsule endoscopy if you have any of the following:

• Stricture (narrowing) of the bowel
• Gastrointestinal fistulae
• Large diverticulae
• Pregnancy
• Care should be taken if you have pacemakers or other implanted electrical devices