I'm having a Wireless Capsule Enteroscopy on Tuesday, July 8th

I have been having a problem with anemia now for almost a year and a half.  I am going to have a wireless Capsule Enteroscopy done on Tuesday.   I've had both an Endoscopy and Colonoscopy with negative results so my Dr. and I have decided to do this test to do further investigation of my small intestine..  I am sick and tired or being sick and tired most of the time. I hope they find something so we know what we are dealing with and can treat it!

What is wireless capsule enteroscopy? 

Wireless Capsure Enteroscopy (also known as capsule endoscopy, wireless endoscopy, and the "pill cam") is a relatively new method of diagnosing diseases within the small intestine.

For the procedure a pill sized video capsule is swallowed, which slowly travels through your bowels before being naturally excreted several hours later. The capsule has its own built-in light and camera to take pictures of the walls of the bowel and detect obscure bleeds or small bowel tumers, ulcers or abnormal vascular masses. 2-4 images are taken per second for up to 8 hours. The images are transmitted to a recorder that is worn around the waist.

You may require this investigation if you have abnormal  bleeding or are suspected to have Crohns disease. This investigation is non-invasive and allows doctors to examine all three portions of the small intestine (duodenum, jejunum and ileum)  which often cannot be reached by other imaging methods.  

What is capsule enteroscopy used for?

Capsule enteroscopy allows your doctor to visualise the small intestine which is often missed by conventional imaging methods such as upper gastrointestinal endoscopy or colonoscopy. The most common reason for ordering this investigation is to look for sources of bleeding. You may have noticed blood in your vomit or faeces, or have unnoticed blood loss that can cause iron deficiency anemia. This investigation can identify polyps, inflammatory bowel disease (Crohn's disease or  ulcerative colitis), ulcers and tumours that may be the source of the bleeding. Such lesions may not have been found by previous investigations but once identified, your doctor can decide an appropriate course of management.

The other main use is for evaluating the extent of Crohn's disease, which commonly affects the small intestine. This investigation is particulary useful for detecting early disease which may be missed by barium examination and computed tomography (CT). Also it can be useful in patients who have symptoms which do not match the extent of disease (if any) seen by conventional imaging techniques.

Wireless capsule enteroscopy may have further indications in the future as it is safe, easy to perform, non-invasive and doesn't require sedation. In particular, if techniques are invented that allow treatments or biopsies (tissue sampling) to be performed at the time of procedure, it will become a very useful procedure.

What does the procedure involve?

For the procedure, I will be required to swallow a 26x11mm endoscopy capsule (about the size of a jelly bean) equipped with a video camera, light source, radio transmitter, and batteries. The capsule is swallowed with a substance called simethicone, to prevent bubbles forming and interfering with the images.

The capsule passes naturally through the body via peristalsis (contraction and propelling by the muscular walls of the gastrointestinal tract) while it takes many images. The images are detected by a sensor device attached to my abdomen with 8 small aerials taped to the skin (similar to the electrodes used for an ECG). These are recorded and stored on the image recorder worn around my waist.

After approximately 8 hours I will be required to return to the medical center so the images can be downloaded and examined on a computer monitor by my physician. Around 50,000 images will be taken per investigation, so it can take a long time for these to be examined and processed. My doctor will normally inform me of the results within a week.

I should pass the capsule naturally after 8-72 hours, but it can sometimes take up to two weeks. If I haven't passed the capsule by this time, an X-ray may need to be performed to see if it is still present or obstructed. The capsule is discarded after it has been excreted.