Capsule Endoscopy

Everything You Need to Know About Capsule Endoscopy Equipment

Capsule endoscopy (CE) is a procedure that uses a tiny wireless camera to record internal images of the gastrointestinal tract. The size and shape of the camera are the same as a standard pharmaceutical capsule. It contains a tiny camera and is LED-powered by a battery. When a patient swallows this capsule, it takes many images in seconds while passing through the gastrointestinal tract. These images become transmitted to an array of receivers connected with a portable recording system carried by the patient. Its primary use is to observe areas of the small intestine, which is an area that cannot be reached by traditional procedures. Traditional procedures involve passing a soft, long, and flexible tube with an attached camera down to the throat or through the rectum. When the recorder is ready and connected, the patient must swallow it with water. Once taken, the patient is unable to feel its presence in their intestine.

The history of capsule endoscopy equipment

In 2001, clinical gastroenterology welcomed capsule endoscopy with the certificate of clearance by the US Food and Drugs Administration. This journey of concept to implementation started in 1981 when a senior engineer from the research and development branch of the Israeli defense ministry, Gavriel Iddan, took a leave from his regular job. He was interested in medical imaging and spent his holiday in the detailed study of ultrasound and X-ray imaging for a company dedicated to medical imaging services in Boston named "Elscint." One of his neighbors, Eitan Scapa, who was an Israeli gastroenterologist, was spending his sabbatical in a medical institution in Boston as well. These two befriended, and Iddan learned the use of fiber optics. Scapa told Iddan about the technology of fiber optics. He explained that Fiber optics had left the small bowl out of reach for medical inspection. Iddan became aware of the challenge and started to think about the solution. At that time, a small charged coupled device (CCD) touched the market. Ten years later, when Iddan was on his second sabbatical, he considered the use of a CCD camera with connections with an electrical umbilical cord. 

A group of doctors from England in 2000 reported using and producing a new instrument to determine internal bleeding in the digestive system. A device, named, CE, that was 1-1/8 inches long and 3/8 inches wide. It was the same in size as a big-sized pill with 8 hours battery, camera, light source, and a transmitter. This capsule camera could take two pictures in just one second and a total of 55,000 photos. After 8 hours of digestion, the camera sends the images to an external monitor of a computer. These pictures are stored and processed for later analysis.

Indications to use capsule endoscopy equipment

The primary use of capsule endoscopy equipment is in gastroenterology. It helps to diagnose several disease processes, including:

Gastrointestinal bleeding

This is probably the most common reason for its use. Capsule endoscopy equipment is used to find the cause of bleeding in the small intestine. First, patients with unexplained and obscure iron deficiency anemia or losing their blood from an unknown cause in the Gastrointestinal tract get evaluated with a colonoscopy and then upper E(EDG). If these tests show no identification of blood loss, then the very next step to finding the reason for blood loss is CE. The primary causes of bleeding from the small bowel are ulceration, tumors, masses, rare hereditary conditions, and inflammation.

Bowel diseases

Capsule endoscopy equipment can explore the areas of inflammation in the small bowel. It can be helpful to evaluate tumors such as carcinoids, carcinomas, and lymphoma.

Polyps screen

People with inherited syndromes causing polyps in the small intestine may undergo capsule endoscopy.

Esophagus examination

The use of CE is a recognized evaluation of a muscular tube, which connects the mouth and stomach. It looks for abnormal and enlarged veins.

Cancer diagnosis

It helps to show the small intestine in a detailed manner, capturing the images of tumors in the small intestine or anywhere else in the digestive system.

Celiac disorders

Capsule endoscopy is sometimes useful in diagnosing and monitoring the immune reactions of eating gluten and celiac disorders.

Follow up tests after X-rays

Often, if an imaging test or x-ray is unclear, CE is useful in getting precise imaging results. A doctor may recommend CE to get comprehensive information.

CE can help in obscure bleeding, anemia, abdominal pain, diarrhea, suspension of small bowel tumors, and loss of protein enteropathy. The recommendation criteria of CE is stenosis or suspicious stenosis of the gastrointestinal tract and pregnancy. Many other indications are under consideration. 

Complications

Although with a few complexities, CE is generally a very safe process. It carries a few risks. Side effects like retention of the capsule and aspiration occur in less than 2% of patients. No conventional sources are available to predict or prevent its retention. Recently, a modified form launched to determine patency in patients with the risk of having possible strictures. The small risk might become a more significant problem for the patient with diseases such as cancer, previous treatment, and surgery in the area. Crohn's disease may become a reason for narrowing stricture in the digestive tract. A small chance of getting stuck is present even if the CT scanner shows no narrowing. The doctor might give the capsule time to leave the body when it doesn't pass in a bowel movement and does not cause symptoms and signs. But, a retained capsule, showing signs and symptoms, must be removed by surgery or a traditional treatment of E process, and it depends on the place where the cap is stuck. So, its retention is the only and most notable risk and complication, although its occurrence is meager. The primary danger with CE is the possible retention of the device. Patients with a history of undergoing tests for evaluation for bleeding are at a very lower risk of about two percent. In patients with Crohn's disease, this risk may increase to four to five percent. Mostly, cases are resolved quickly after the delay in its passage. In very few and rare cases, the small bowel shows abnormalities by blocking the passage.  The notable thing is that this technology is only for diagnostic purposes and is not useful in biopsy or treatment of any condition.

How it works

Pre-Procedure instructions 

  • Take a very light breakfast and clear liquids for lunch and dinner. 
  • Smoking is not allowed for 24 hours before CE. 
  • Take your essential medicines a minimum of 2 hours before CE or postpone them until 4 hours after the procedure.

Procedure

It can be performed while you go about your routine activities. The doctor will place several electrodes on your abdominal part in the exam room. The electrodes are attached to the data recorder to receive signals of images. After this, the doctor gives a capsule, which has a tiny camera, to the patient. The patient is free now to leave the exam room and resume normal activities for approximately 8 hours. The patient does not feel it as it will move through the digestive tract.

Post Procedure precautions

Here are instructions to follow the process of CE.

  • Stop eating or drinking for two hours.
  • After four hours, light snacks are allowed.
  • Avoid Strenuous activity such as running, bending, jumping, etc.
  • Avoid adjusting the recorder.
  • If nausea, vomiting, or abdominal pain occurs, the patient should go back to the doctor immediately.
  • After 8 hours, the patient must go to the doctor for the removal of the recorder. If it does not pass out, the patient should visit the doctor and notify. 

Market Leaders

Following is the list of the companies which supply CE globally.  

  • Olympus Corporation
  • MEDTRONIC
  • Fujifilm Holding Corporation
  • IntroMedic Co. Ltd
  • RF System lab
  • CapsoVision 
  • JINSHAN Science and Technology

Alternative Instruments

X-rays and sonography are alternative tests to investigate the gastrointestinal tract (GIT). Still, CE is the most effective and efficient procedure compared to those.

General Specifications

There are several designs of this instrument on the market, with different specifications. However, we are going to cite the general specifications, which should be accurate enough.

  •  Length: 28mm
  •  Diameter: 12mm
  • Images resolution: 320 × 240
  • Images compress them into JPEG form
  • Size of picture: 15k
  • Frequency: 2 frames per second
  • Working time: 5 hours
  • Taking the JPEG form of images is more effective and more precise for this procedure.

Conclusion

Hence, capsule endoscopy equipment is invaluable for the screening and diagnosis of the small bowel, having some adverse effects like small bowel obstruction, capsule retention, perforation, and aspiration. It aids in finding out the cause of bleeding in the GIT. The camera takes many pictures of the gastrointestinal tract in a short time and ultimately finds the underlying causes with the least side effects compared to conventional endoscopy. It is the least cost-effective and well-tolerated safe procedure. Its only complication is capsule retention, which has a 0.75 percent chance of occurrence in testing patients.  Invention and advancement in CE enable the health professional in the early and accurate diagnosis of cancer, Cohn disease, GIT bleeding. It increases the treatment chances early toward gaining healthy and quality of life in the patient.