Is this the end of the endoscopy? Patients could avoid invasive procedure by swallowing a tiny camera inside a pill

WITH less invasive treatments well established, for example laparoscopic (key hole) surgery which doesn’t involve large incisions, it is only natural that methods of investigating disease are developed which are less labour intensive, less painful and which disrupt the person’s daily life to a lesser degree.

Capsule endoscopy, also referred to as Video Capsule Endoscopy (VCE), or wireless capsule endoscopy (WCE) is one such technique. Already available in the USA and elsewhere, it is being trialled in 11,000 patients, over 40 sites across England, and has been described by Sir Simon Stevens, head of the NHS, as “ingenious”.

The investigation of disorders of the gastrointestinal (GI) tract, has traditionally involved endoscopic (camera) procedures. These require a hospital attendance of several hours, skilled personnel to carry out the test and an appropriate facility. Although millions of endoscopies have been successfully performed, they are sometimes poorly tolerated, resulting in the procedure having to be abandoned.

Complications include pain, bleeding and on rare occasion, perforation of the gullet or bowel. Examination of the upper GI tract stops at the first part of the small intestine, and colonoscopy only reaches as far as the start of the lower GI tract (large bowel). The majority of the small bowel is not reached. Disorders found here include cancerous as well as non-cancerous conditions, both vital to identify.

Screening programmes for bowel cancer have resumed, but concern remains that some with symptoms of potential malignancy are not approaching healthcare services due to fears surrounding Covid.

Capsule endoscopy involves swallowing a pill with a coated surface to make it more slippery. The pill slides down the entire gastrointestinal tract, taking two photographs per second on a journey that typically lasts five to eight hours.

Patches are attached to the abdomen to receive images which are then uploaded to a data recorder, either worn around the waist, or in a shoulder bag. Some devices do not require patches.

You attend for approximately half an hour to be kitted up and swallow the pill. You can then go about your daily business, usually being able to have a drink two hours later and a light meal at four.

The data recorder is handed back later the same day, or perhaps the day after. Mercifully there is no need to fish the capsule out of the toilet bowl. It is entirely disposable.

Although there are many benefits to capsule endoscopy, as outlined above, it is not without its limitations nor is it entirely without risk.

Although small, some may struggle to swallow the capsule, particularly those with a swallowing disorder. The instrument may fail, which can be said of any electronic device.

Capsule endoscopy requires bowel preparation similar to traditional endoscopy, which can result in dehydration especially in frail patients. Inadequate bowel preparation may mean parts of the gastrointestinal tract being less well visualised, or not at all.

The capsule may get stuck in a narrowing, typically caused by disease, causing bowel obstruction. Symptoms include nausea, vomiting, abdominal bloating and not passing any wind.

This may require traditional endoscopy to retrieve the device, or in worst case scenarios, a formal operation. However, a CT scan before capsule endoscopy will identify any narrowing of significance, and dummy pills exist to perform a “dry run”. These dissolve if stuck at any point.

The capsule cannot take biopsies or samples of the lining of the intestine, and data may take up to two weeks to process. It is not suitable for those with a pacemaker, other internal electronic device, or pregnant women.

Even after capsule endoscopy, traditional endoscopy may be required. The other side of this argument is that a negative or normal test result may prevent the need for more invasive traditional endoscopy.

We await the results of this trial with hope and optimism, recognising that capsule endoscopy will not replace other methods of investigating gastrointestinal disease, including traditional endoscopy and Computerised Tomography (CT) scanning, but will hopefully add to the list of diagnostic tools that can be used.

Cancers of the GI tract occur in young as well as older individuals. Symptoms of oesophageal (gullet) cancer include difficult or painful swallowing, regurgitation, nausea, vomiting and abdominal pain. New heartburn or worsening of existing symptoms should not be ignored. Complaints associated with lower GI or bowel cancer are abdominal pain, weight loss, altered bowel habit and rectal bleeding. I would urge anyone with such symptoms or any concerns of possible cancer to consult their routine GP as a matter of priority.

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