Browse the corpus

Capsule endoscopy, also known as wireless capsule endoscopy or video capsule endoscopy, is a gastrointestinal study that uses a pill camera to take images of the intestinal lumen. The first capsule endoscopy was performed in 1999, and the US Food and Drug Administration approved its use in the United States in 2001. The M2A capsule (mouth to anus) was the first available pill camera and was eventually renamed as PillCam SB (small bowel). This activity reviews the indications, contraindications of capsule endoscopy and highlights the role of the interprofessional team in managing patients with gastrointestinal pathology. Objectives: Identify the indications for capsule endoscopy. Describe the technique of capsule endoscopy. Recall the limitations of capsule endoscopy. Discuss interprofessional team strategies for improving care coordination and communication in patients undergoing capsule endoscopy and improving outcomes. Access free multiple choice questions on this topic.

Capsule endoscopy, also known as wireless capsule endoscopy or video capsule endoscopy, is a gastrointestinal study that uses a pill camera to take images of the intestinal lumen. The first capsule endoscopy was performed in 1999, and the US Food and Drug Administration approved its use in the United States in 2001. The M2A capsule (mouth to anus) was the first available pill camera and was eventually renamed as PillCam SB (small bowel). The capsule is ingested and transmits images at 2 to 6 frames per second over the course of 8 to 12 hours until the battery expires. It generates 512 by 512-pixel, high-resolution images that allow detailed inspection of the gastrointestinal mucosa. A trained gastroenterologist then reviews the images. Battery life can be a limiting factor during capsule endoscopies, and 16.5% of studies are incomplete due to battery expiration. Capsule endoscopy is a diagnostic procedure and has no therapeutic benefits. It can only localize lesions in the esophagus, stomach, small bowel, and colon but cannot be used for biopsy or therapy. It is used most often for recurrent and obscure gastrointestinal bleeding after traditional endoscopic procedures have failed to identify a bleeding source. It can be a useful study for localizing a lesion prior to angiography, surgery, or further endoscopic procedures. The diagnostic yield of capsule endoscopy has been found to be higher than small bowel barium studies, CT enteroclysis, angiography, and push enteroscopy.[1][2][3]

Capsule retention can occur in 1.3% to 1.4% of patients undergoing capsule endoscopy and is the most common complication. Capsule retention is usually asymptomatic and diagnosed 2 weeks after capsule ingestion via abdominal plain film x-ray. Patients with known or suspected obstructions, strictures or fistulas should not undergo capsule endoscopy due to their increased risk of retention. Crohn's disease increases a patient’s risk of having capsule retention to 2.6%. A dummy capsule called an Agile Patency Capsule can be used to determine patency of the intestinal lumen for the safe use of capsule endoscopy. Radiographic imaging such as small-bowel follow-through, CT or magnetic resonance enterography can also be used to assess lumen patency prior to the administration of the capsule. Capsules may need to be surgically or endoscopically removed if symptomatic retention occurs. The video capsule can also be retained in a Zenker or Meckel's diverticulum. There is a small risk for aspiration of the capsule or cricopharyngeal impaction of the capsule.[13][14]

Capsule endoscopy does have a role in the detection of some gastrointestinal disorders but it is rarely the first test of choice. It is most useful for detecting superficial or occult lesions that are not detected by other imaging studies. In patients with obscure recurrent bleeding or those with chronic intestinal diseases such as Crohn's disease, capsule endoscopy provides a thorough yet minimally invasive evaluation. However, due to the potential for retention, this diagnostic test needs to be administered judiciously. The clinician needs to review the indications and limitations of this procedure with the patient to ensure efficacy. The nurse plays a crucial role in educating the patient about the possible signs of complications and adverse outcomes. The nurse will also help assess the medical team in reviewing past medical history for contraindications for the procedure as well as the patient's capacity to undergo the procedure in the first place. If adverse events should occur, the nurse should communicate with the providers to minimize patient harm. A collaborative interprofessional team can help the efficacy and efficiency of capsule endoscopy and improve patient outcomes. (Level V)