capsule endoscopy

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capsule endoscopy

visualization of the bowel lumen and wall by a swallowed camera.
A non-invasive gastrointestinal endoscopy procedure in which a patient swallows a disposable 1.0 X 2.5 cm ‘pill’ containing a camera electronically linked to equipment housed in a holster outside of the patient which records images as it passes from the oesophagus through the entire tract and is excreted in the faeces.
Indications Imaging the small intestine between the distant duodeno-jejunal ‘junction,’ which is beyond the reach of upper GI endoscopy and the terminal ileum and is similarly beyond the reach of colonoscopy. It is of greatest use in identifying points of bleeding and ulcers

capsule endoscopy

Abbreviation: CE.
Endoscopy of the gastrointestinal tract with a pill that contains a miniature camera. The pill is swallowed by the patient and travels through the gut unaided. CE is used to examine the small intestine, which is difficult to reach with standard upper endoscopy or with colonoscopy. CE can be used to identify otherwise occult sources of gastrointestinal bleeding.

CAUTION!

In patients with gastrointestinal strictures the camera may become lodged in the narrows and occasionally may need to be removed surgically.
Synonym: video endoscopy; wireless capsule endoscopy
See also: endoscopy

Capsule Endoscopy

Synonym/acronym: Pill GI endoscopy.

Common use

To assist in visualization of the GI tract to identify disease such as tumor and inflammation.

Area of application

Esophagus, stomach, upper duodenum, and small bowel.

Contrast

None.

Description

This outpatient procedure involves ingesting a small (size of a large vitamin pill) capsule that is wireless and contains a small video camera that will pass naturally through the digestive system while taking pictures of the intestine. The capsule is 11 mm by 30 mm and contains a camera, light source, radio transmitter, and battery. The patient swallows the capsule, and the camera takes and transmits two images per second. The images are transmitted to a recording device, which saves all images for review later by a health-care provider (HCP). This device is approximately the size of a personal compact disk player. The recording device is worn on a belt around the patient’s waist, and the video images are transmitted to aerials taped to the body and stored on the device. After 8 hr, the device is removed and returned to the HCP for processing. Thousands of images are downloaded onto a computer for viewing by an HCP specialist. The capsule is disposable and will be excreted naturally in the patient’s bowel movements. In the rare case that it is not excreted naturally, it will need to be removed endoscopically or surgically.

This procedure is contraindicated for

  • high alertPatients who have had surgery involving the stomach or duodenum, which can make locating the duodenal papilla difficult.
  • high alertPatients with a bleeding disorder.
  • high alertPatients with unstable cardiopulmonary status, blood coagulation defects, or cholangitis, unless the patient received prophylactic antibiotic therapy before the test (otherwise, the examination must be rescheduled).
  • high alertPatients with unstable cardiopulmonary status, blood coagulation defects, known aortic arch aneurysm, large esophageal Zenker’s diverticulum, recent gastrointestinal (GI) surgery, esophageal varices, or known esophageal perforation.

Indications

  • Assist in differentiating between benign and neoplastic tumors
  • Detect gastric or duodenal ulcers
  • Detect gastrointestinal tract (GI) inflammatory disease
  • Determine the presence and location of GI bleeding and vascular abnormalities
  • Evaluate the extent of esophageal injury after ingestion of chemicals
  • Evaluate stomach or duodenum after surgical procedures
  • Evaluate suspected gastric obstruction
  • Identify Crohn’s disease, infectious enteritis, and celiac sprue
  • Identify source of chronic diarrhea
  • Investigate the cause of abdominal pain, celiac syndrome, and other malabsorption syndromes

Potential diagnosis

Normal findings

  • Esophageal mucosa is normally yellow-pink. At about 9 in. from the incisor teeth, a pulsation indicates the location of the aortic arch. The gastric mucosa is orange-red and contains rugae. The proximal duodenum is reddish and contains a few longitudinal folds, whereas the distal duodenum has circular folds lined with villi. No abnormal structures or functions are observed in the esophagus, stomach, or duodenum.

Abnormal findings related to

  • Achalasia
  • Acute and chronic gastric and duodenal ulcers
  • Crohn’s disease, infectious enteritis, and celiac sprue
  • Diverticular disease
  • Duodenal cancer, diverticula, and ulcers
  • Duodenitis
  • Esophageal or pyloric stenosis
  • Esophageal varices
  • Esophagitis or strictures
  • Gastric cancer, tumors, and ulcers
  • Gastritis
  • Hiatal hernia
  • Mallory-Weiss syndrome
  • Perforation of the esophagus, stomach, or small bowel
  • Polyps
  • Small bowel tumors
  • Strictures
  • Tumors (benign or malignant)

Critical findings

    N/A

Interfering factors

  • Factors that may impair clear imaging

    • Gas or feces in the GI tract resulting from inadequate cleansing or failure to restrict food intake before the study.
    • Retained barium from a previous radiological procedure.
  • Other considerations

    • The patient should not be near any electromagnetic source, such as magnetic resonance imaging (MRI) or amateur (ham) radio equipment.
    • Undergoing an MRI during the procedure may result in serious damage to the patient’s intestinal tract or abdomen. The patient should contact his or her HCP for evaluation prior to any other procedure.
    • Delayed capsule transit times may be a result of narcotic use, somatostatin use, gastroparesis, or psychiatric illness.

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this procedure can assist in assessing the esophagus, stomach, and upper intestines for disease.
  • Obtain a history of the patient’s complaints or clinical symptoms, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of the patient’s gastrointestinal system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Ensure that this procedure is performed before an upper GI series or barium swallow.
  • Record the date of the last menstrual period and determine the possibility of pregnancy in perimenopausal women.
  • Obtain a list of the patient’s current medications, including anticoagulants, aspirin and other salicylates, herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus). Such products should be discontinued by medical direction for the appropriate number of days prior to a surgical procedure. Note time and date of last dose.
  • Review the procedure with the patient. Address concerns about pain and explain that no pain will be experienced during the procedure. Inform the patient that the procedure is begun in a GI laboratory or office, usually by an HCP or support staff, and that it takes approximately 30 to 60 min to begin the procedure.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Instruct the patient to stop taking medications that have a coating effect, such as sucralfate and Pepto-Bismol, 3 days before the procedure.
  • Instruct the patient to abstain from the use of tobacco products for 24 hr prior to the procedure.
  • Instruct the patient to start a liquid diet on the day before the procedure. From 10 p.m. the evening before the procedure, the patient should not eat or drink except for necessary medication with a sip of water. Instruct the patient to take a standard bowel prep the night before the procedure. Protocols may vary among facilities.
  • Instruct the patient not to take any medication for 2 hr prior to the procedure.
  • Inform the patient that there is a chance of intestinal obstruction associated with the procedure.
  • Instruct the patient to wear loose, two-piece clothing on the day of the procedure. This assists with the placement of the sensors on the patient’s abdomen.
  • Make sure a written and informed consent has been signed prior to the procedure.

Intratest

  • Potential complications: N/A
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient.
  • Ensure that the patient has complied with dietary and medication restrictions and pretesting preparations for at least 8 hr prior to the procedure.
  • Obtain accurate height, weight, and abdominal girth measurements prior to beginning the examination.
  • Instruct the patient to cooperate fully and to follow directions.
  • Ask the patient to ingest the capsule with a full glass of water. The water may have simethicone in it to reduce gastric and bile bubbles.
  • After ingesting the capsule, the patient should not eat or drink for at least 2 hr. After 4 hr, the patient may have a light snack.
  • After ingesting the capsule and until it is excreted, the patient should not be near any source of powerful electromagnetic fields, such as MRI or amateur (ham) radio equipment.
  • The procedure lasts approximately 8 hr.
  • Instruct the patient not to disconnect the equipment or remove the belt at any time during the test.
  • If the data recorder stops functioning, instruct the patient to record the time and the nature of any event such as eating or drinking.
  • Instruct the patient to keep a timed diary for the day detailing the food and liquids ingested and symptoms during the recording period.
  • Instruct the patient to avoid any strenuous physical activity, bending, or stooping during the test.

Post-Test

  • Instruct the patient to resume normal activity, medication, and diet after the test is ended or as tolerated after the examination, as directed by the HCP.
  • Instruct the patient to remove the recorder and return it to the HCP.
  • Patients are asked to verify the elimination of the capsule but not to retrieve the capsule.
  • Inform the patient that the capsule is a single-use device that does not harbor any environmental hazards.
  • Emphasize that any abdominal pain, fever, nausea, vomiting, or difficulty breathing must be immediately reported to the HCP.
  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Decisions regarding the need for and frequency of occult blood testing, colonoscopy, or other cancer screening procedures should be made after consultation between the patient and HCP. The American Cancer Society recommends regular screening for colon cancer, beginning at age 50 yr for individuals without identified risk factors. Their recommendations for frequency of screening: annual for occult blood testing (fecal occult blood testing [FOBT] and fecal immunochemical testing [FIT]); every 5 yr for flexible sigmoidoscopy, double contrast barium enema, and computed tomography (CT) colonography; and every 10 yr for colonoscopy. There are both advantages and disadvantages to the screening tests that are available today. Methods to use DNA testing of stool are being investigated and await FDA approval. The DNA test is designed to identify abnormal changes in DNA from the cells in the lining of the colon that are normally shed and excreted in stool. The DNA tests under development use multiple markers to identify colon cancers that demonstrate different, abnormal DNA changes. Unlike some of the current screening methods, the DNA tests would be able to detect precancerous polyps. The most current guidelines for colon cancer screening of the general population as well as of individuals with increased risk are available from the American Cancer Society (www.cancer.org), U.S. Preventive Services Task Force (www.uspreventiveservicestaskforce.org), and the American College of Gastroenterology (www.gi.org). Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be needed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include barium enema, barium swallow, biopsy intestinal, cancer antigens, colonoscopy, CT abdomen, CT colonoscopy, esophageal manometry, esophagogastroduodenoscopy, fecal analysis, folate, gastric acid emptying scan, gastric acid stimulation test, gastrin, Helicobacter pylori, KUB studies, MRI abdomen, PET pelvis, proctosigmoidoscopy, upper GI and small bowel series, US abdomen, and vitamin B12.
  • Refer to the Gastrointestinal System table at the end of the book for related tests by body system.
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