An endoscopy is a medical procedure that involves the use of a thin and long flexible tube, known as an endoscope with a video camera at one end and a lens at the other to view the inside of the body. While the endoscope was developed in the 1800s, it has evolved over the years and has become an integral component in many medical fields, including gastroenterology. This procedure allows specialists to carry out a number of diagnostic tests and surgical procedures without incisions and complications that are usually associated with invasive techniques. Today, there are many types of endoscopies with novel technologies like capsule endoscopy, which have increasingly become popular among many gastroenterologists worldwide. Through this article, we will enlighten you about what capsule endoscopies are, their benefits, how they differ from conventional endoscopies and more!

Endoscopy

Before we delve into capsule endoscopy, let’s learn more about how a conventional endoscopy works and why it is necessary. In conventional endoscopy, the endoscope is inserted into the body through the oral cavity (upper endoscopy) or rectum (colonoscopy).

Whether you need an upper endoscopy or a colonoscopy will depend on the condition you have or the symptoms you present. For instance, if a patient comes with chronic stomach pain or is suffering from a condition like coeliac disease or gastroesophageal reflux (GERD), the gastroenterologist will most likely perform an upper endoscopy for further evaluation. Similarly, if the complaint is about a concern that affects the large intestines, including the rectum and anus, a colonoscopy might be carried out. However, in addition to upper endoscopy and colonoscopy, there are many different types of endoscopies to visualise the insides of different organs and structures, including a gastroscopy to view the upper gastrointestinal tract (GI), and an endoscopic retrograde cholangiopancreatography (ERCP) for the examination of the liver, gallbladder, bile ducts, and pancreas.

Endoscopy procedure in Singapore: Benefits

In the realm of gastroenterology, endoscopies can be used for addressing various gastrointestinal concerns, including heartburn, nausea and vomiting, bleeding, and pain. A number of GI conditions can also be diagnosed using the endoscopy procedure in Singapore such as gastritis, gastric and duodenal ulcers, strictures, inflammatory bowel disease or IBD (Ulcerative colitis and Crohn's disease), and Barrett’s oesophagus. Furthermore, endoscopies play a significant role in gastrointestinal cancer management – cancer staging. But endoscopies are not only used for diagnostic purposes or cancer staging. They can also be utilised for treating problems like bleeding varices, polyps and other abnormal growths (for removal), and blockages (opening up any strictures). In addition, an endoscopy can be useful when placing feeding or drainage tubes.

Let’s walk through many other benefits that come with an endoscopy procedure in Singapore:

• Enhanced and targeted visualisation: As the gastroenterologist can control the movements of the endoscope, it allows them to have a direct and enhanced visualisation of the areas of concern.
• Real-time imaging: As this is carried out in real-time, the specialist will be able to take the necessary intervention during the procedure.
• Minimally invasive procedure: The endoscopy procedure in Singapore is minimally invasive, which means the patient will be subject to very low rates of adverse risks and complications, such as an injury to the lining of the digestive tract. 

Endoscopy procedure in Singapore: Limitations

• Requires sedation: Although it’s not a surgical procedure that involves making any incisions, the patient may need sedation to avoid any pain or discomfort, as the endoscope has to be inserted into the body.
• Restricted access: Some structures or locations of the body might not be easily accessible with the conventional endoscopy procedure in Singapore, requiring alternative modalities or solutions such as capsule endoscopy.

Capsule Endoscopy: Benefits

As the name suggests, capsule endoscopies necessitate the swallowing of a pill-like capsule containing a wireless camera to capture images of the digestive tract. These are then transmitted into a computer through recording equipment. Patients usually wear this recording device on a belt around their waist. Capsule endoscopy can be used to evaluate a number of concerning digestive symptoms, such as dysphagia (difficulty in swallowing), abdominal bloating, discomfort and pain, as well as GI bleeding. Moreover, capsule endoscopy is useful in diagnosing many GI conditions, including ulcers, varices, polyps, IBD, coeliac disease, and gastrointestinal tumours. As mentioned before, this is beneficial in accessing areas that are not easily reached by a conventional endoscopy, but this isn’t the only advantage associated with this procedure.

Let’s take a look at a number of different benefits that come with performing capsule endoscopy:

• Comprehensive visualisation: The ability to access any location enables the capsule endoscopy to provide an in-depth look at the targeted regions.
• No sedation: As this procedure works by a small pill-like device, no sedation is required.
• Non-invasive: Unlike conventional endoscopies, capsule endoscopy has the added benefit of being completely non-invasive, mitigating the need for any downtime for recuperation as the risk of getting complications is little to none.

Capsule Endoscopy: Limitations

• Obstruction: The pill may take hours or days to pass through the tract before it is eliminated naturally from the body, so there might be a slight risk of the pill getting lodged inside, resulting in bowel obstruction. However, it must be noted that the odds of this occurring are minimal.
• Limited control: Unlike conventional endoscopies, where the gastroenterologist could manoeuvre the device, capsule endoscopy comes with the drawback of no real-time control.
• No therapeutic interventions: As mentioned before, a lack of control over the capsule endoscopy would result in the disadvantage of not being able to perform any treatment interventions immediately.

Summary

Capsule endoscopy is an innovative and minimally invasive procedure that is beneficial in visualising areas that are not examined well by conventional endoscopy. With little to no complication risks and enhanced imaging, it is a useful adjunct in the clinical management of many patients with gastrointestinal diseases.

Frequently Asked Questions

How long does it take to carry out an endoscopy procedure in Singapore?

While an upper GI endoscopy may take around 15 to 20 minutes, a colonoscopy might need around 30 to 40 minutes to complete. But in order for the sedation to wear off, recovery, discharge and depending on the patient’s condition, these timings may vary and extend up to one to two hours or more.

How long does it take to carry out Capsule Endoscopy in Singapore?

As mentioned previously, the pill may take hours to days to be eliminated. Therefore, the duration may vary from individual to individual. However, most patients usually pass out the pill within a day or two.

Does it hurt to carry out a conventional endoscopy or Capsule Endoscopy?

No. As the patient is typically sedated in a normal endoscopy, the patient usually does not experience any pain or discomfort. Capsule endoscopy will also not cause any pain or discomfort as it is non-invasive unless a bowel obstruction occurs (rare).

How do I prepare for both procedures?

For an endoscopy, you will be required to fast overnight (no food or drinks), and your doctor may ask you to avoid taking certain medications, such as blood thinners. Prior to the capsule endoscopy, you will also be asked to fast overnight and might be given laxatives to flush out the small intestines to get quality imaging.

Can I consult a gastroenterologist to perform my Capsule Endoscopy?

Absolutely! Your gastroenterologist will assess you and determine if capsule endoscopy is necessary and if you are suitable for it. For more information on capsule and conventional endoscopies, contact our dedicated team, who will guide you with all your concerns and help you schedule an appointment with our well-experienced gastroenterologist, Dr Benjamin Yip.

Our clinic offers a range of comprehensive treatments and services, including endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP), endoscopic mucosal resection (EMR), deep enteroscopy, and more. Furthermore, if you want to learn more about these investigations, like the advantages of endoscopic ultrasound imaging or need advice on lifestyle changes for a healthier digestive system and other insights, feel free to browse our blog articles.

References: 

1. Mayo Clinic. “Capsule endoscopy”, September 18, 2021. https://www.mayoclinic.org/tests-procedures/capsule-endoscopy/about/pac-20393366 Accessed August 22, 2023.
2. Cleveland Clinic. “Capsule Endoscopy” https://my.clevelandclinic.org/health/diagnostics/16829-capsule-endoscopy Accessed 23 August 2023.
3. Healthline. “Endoscopy”, 12 October 2018. https://www.healthline.com/health/endoscopy#new-endoscopy-techniques Accessed 23 August 2023.
4. NHS. “Endoscopy”.https://www.nhs.uk/conditions/endoscopy/ Accessed 24 August 2023.
5. Cancer.Net. “Types of Endoscopy”, The ASCO Foundation https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/types-endoscopy Accessed 24 August 2023.