What is Capsule Endoscopy?

A capsule endoscopy is a diagnostic procedure used to visualise the inside of your digestive tract, which begins at the mouth and ends at the anus. During a capsule endoscopy, a tiny wireless camera encased inside a small, pill-sized capsule is used to capture images (2 pictures every second for 8 hours) of the digestive tract. The capsule is typically swallowed and then passed out in the stool after a day or two. As it passes through the digestive tract, the camera will take photos that are transmitted to a recorder attached to a belt around your waist. 

Capsule endoscopies are usually done to look at areas of the digestive tract that cannot be easily accessed and visualised by traditional endoscopy procedures such as gastroscopy and colonoscopy. Endoscopy is the process in which a small, hollow tube is passed in either through the mouth to visualise the oesophagus and stomach or through the anus to visualise the large intestine. Such areas that are better visualised by capsule endoscopy include the small intestine, which is not typically inspected during traditional endoscopy.

How big is the Capsule Endoscopy device?

The capsule is about the size of a jelly bean or a typical vitamin pill (11mm x 26mm) and weighs less than 4 grams. 

What is Capsule Endoscopy for?

Typically, capsule endoscopy is used to look at the small intestine. A capsule endoscopy may be recommended by your doctor to: 

• Screen for a cause of gastrointestinal bleeds, especially for a source of unexplained bleeding in the small intestine.

• Screen for a cause of unexplained abdominal pain that could not be located and identified with the first round of imaging studies.

• To screen for ulcers in the digestive tract, including stomach ulcers and duodenal ulcers, which can be a cause of abdominal discomfort and gastrointestinal bleeding.

• To look for any growths in the digestive tract, including polyps and tumours, that may have malignant potential.

• To diagnose inflammatory bowel diseases, such as Crohn’s disease and celiac disease, by revealing any areas of inflammation in the small intestine.

• For further investigative purposes, after x-rays or other imaging studies for which the results are unclear or inconclusive.

The small intestine used to be a "no man's land" for Gastroenterologists. With the advent of the capsule endoscope, your Gastroenterologist is able to have a detailed look at your small intestines before embarking on more invasive procedures, such as deep enteroscopy or referring on for surgery.

How safe is Capsule Endoscopy?

Capsule endoscopies are usually safe procedures. However, although rare, they do carry a few risks, which include: 

• Having the capsule get stuck in the digestive tract such that it cannot be passed out in the stool. In turn, this may lead to bowel obstructions. In such cases, further tests can be run, such as a CT scan, to locate the capsule or to ensure that it is no longer in the body in case it was passed out in stools but was missed. 

• Causing obstruction in the small intestine

Patients should not undergo an MRI scan after a capsule endoscopy procedure before the capsule is passed out. 

What can I expect during Capsule Endoscopy in Singapore?

You will need to fast before the night of the procedure, so as to improve the visualisation of the digestive tract and the quality of the images that the wireless camera will capture.

During the capsule endoscopy procedure, you will first be instructed to wear a sensor belt which will record and store the images captured by the capsule endoscopy as it travels through the digestive tract. The sensor belt will be worn for about 8-10 hours. Once the recorder is connected and ready, you will be asked to swallow the camera capsule with some water. As there is a slippery coating around the capsule, it is relatively easy to swallow, and you will not feel any discomfort. 

You will typically be able to continue to perform normal daily activities after the capsule is swallowed. However, some restrictions such as avoiding running, jumping or strenuous activity may be recommended. There may also be a recommendation that you wait a few hours before eating and drinking again to facilitate endoscope passage through the alimentary tract. 

After the day passes, the capsule will be passed out into the stool. This usually takes about 8-10 hours, or up to 1-2 days after the procedure. Instructions will be given to you with regards to how to remove, store, and return the sensors; the capsule endoscope can usually be flushed down the toilet as it is small. 

The images captured into the sensory belt will be examined by your doctor and used to string together a video/ detailed series of the digestive tract. The doctor will then screen for abnormalities in the digestive tract that were captured by the camera. 

It may take a few weeks to receive the results of the capsule endoscopy. With the thousands of images captured by the capsule camera, your doctor will be able to properly examine your digestive tract and will discuss the results with you in due course. 

What if I don’t see the capsule after two weeks?

If the capsule is not seen after two weeks, there is a likelihood that it is stuck. If the capsule does get stuck, further scans such as an x-ray or CT scan may be needed to locate the capsule, or to ensure that it is no longer in the body (in the case that it has been passed out in stools, but was missed).

Are there any side effects?

Given the small size of the capsule camera, there are typically not many side effects that you will experience. Daily life can mostly be resumed once the capsule endoscopy is swallowed, save for the few-hour restrictions about eating and drinking after the swallowing of the capsule. 

How to prepare for a Capsule Endoscopy in Singapore?

The procedure is relatively fast and simple. There is not much to prepare, but you will be required to fast the night before the procedure. Also, your doctor may prescribe you some laxatives to flush out the small intestine beforehand. This is to ensure that the gut is clear and empty, ensuring better visualisation through the quality of images captured by the pill endoscope. 

Once you have consented to the procedure, your doctor will go through the process of capsule endoscopy with you once more and allow you the time to clarify any questions you may have. 

Summary 

In summary, capsule endoscopies are a new and minimally invasive technology that help Gastroenterologists visualise areas that are not typically examined well during traditional endoscopy. 

It is a useful adjunct in the diagnosis and management of gastrointestinal diseases. Given its relative ease of use, low complication risk, and propensity to capture detailed images, capsule endoscopy has proven to be helpful in the clinical management of many patients.