Dr John Wright

Gastroenterologist
MbChB MRCP(UK) PhD

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Capsule Video-Endoscopy

This procedure is the most exciting development in gastroenterology in the recent few years.

The stomach can be examined by a gastroscope and the colon by colonoscope. In between these organs at the top and bottom of the gastrointestinal tract is the small bowel. This is a 3-metre section which is responsible for absorbing all the liquid and foods you ingest.

There is a specialised small bowel endoscope, a double balloon endoscope, which can pass through the small bowel. This is done either through the stomach or colon. It is a difficult and time consuming procedure which also enables specimens to be taken for examination.

A capsule video-endoscope is a specialised camera the size of a large medicine capsule. It takes about 3 pictures a second for 11 hours. These pictures are radioed to a receiver the patient has around the waist for the duration of the test.

The test is totally painless but needs to be done on a completely empty stomach. This requires the most stringent avoidance of any fluid or liquid for 10 hours before the procedure. On arrival in the rooms half a litre of “KleanPrep” is drunk to wash out the stomach and provide a mini-tsunami to clear the small bowel of debris.

The patient returns to the rooms in 10 hours for removal of the waist recorder. The capsule is passed out in the toilet in the normal way.

The only problem with the test is the danger of having a narrowing in the bowel which might hold the capsule back. Fortunately, this has only been a problem in one of my approximately 800 patients when the capsule spent a year inside the patient without causing any harm. It was removed during an incidental abdominal operation and looked as good as when swallowed the previous year. Seriously though we try and avoid this happening. Usually if there is a narrowing it needs to be treated either medically or sometimes surgically when it can be retrieved.

The final problem is the cost, R13 300.00. This is exorbitant. It is however a wonderful tool and most medical aids will fund it if the indication is there. With the correct indications, there is really no alternative to the capsule video-endoscope.