Digestive Health Associates

Southwest Endoscopy Center

Capsule Endoscopy

"Pill camera" Examination

Normal small bowel capsule image
PillCam SB Image of Normal Small Intestine
Images courtesy of Given Imaging, used with permission.

Capsule endoscopy is a technique that allows Digestive Health gastroenterologists to directly view the entire length of small intestine (duodenum, jejunum and ileum), which lies too far downstream to reach through the mouth with routine upper endoscopy, and too far upstream to reach from below during routine colonoscopy.

Examination of the small intestine may be indicated for further evaluation of bleeding, anemia, or diarrhea, particularly if small bowel growths, Crohn's disease or other structural small bowel diseases are suspected but not demonstrated with routine testing.  Capsule endoscopy can be useful for identifying tumors of the small intestine, which typically elude standard diagnostic techniques, including sophisticated CT scans.

Digestive Health is the only facility in Southwest Colorado providing capsule endoscopy. 

Capsule endoscopy is painless.  An empty stomach allows optimal viewing conditions, so you should start a clear liquid diet after lunch the day prior to examination, drink a cleansing solution as directed by our staff on the evening prior to examination, and have nothing to eat or drink, including water, for 10 hours prior to ingesting the capsule.   After you arrive at the clinic a group of electrode skin sensors will be applied to your abdomen and the pill camera is activated.  You then swallow it, and the test is underway.  The endoscopy capsule is about the size of a large vitamin, but easier to swallow because of its smooth surface.  As the capsule travels through the body is takes digital photos (2 per second) and transmits the images to a recorder belt.  You return to the office after 8 hours to have the recorder belt removed.  The capsule passes naturally into the toilet within a few days and is not retrieved.

The principal risk of capsule endoscopy is capsule "retention."  This term is used to describe the capsule becoming "stuck" above a narrowed area of small intestine.  Narrowed areas may result from inflammatory problems or growths.  Published reports of retention suggest that it may occur in 0-13% of tests, depending on the patient's history and diagnoses.  The retention rate is highest in patients with known Crohn's disease, long-term nonsteroidal anti-inflammatory drug use, prior abdominal surgery and prior abdominal radiation therapy.  In the absence of these conditions the retention rate is 1% or less.  Some patients experiencing retention will need surgery to remove the capsule and the area of narrowing, which typically addresses the problem which led to the capsule study being performed in the first place.

If your doctor is concerned that you may be at increased risk for capsule retention he or she may suggest that you first be
pretested with a dissolving "patency capsule" known as the Agile® system, to see if a standard endoscopy capsule (which cannot dissolve) will be able to pass through your intestines without becoming caught and causing a blockage.

Because capsule endoscopy at Digestive Health is designed to image only the small intestine it cannot at this time be a substitute for colonoscopy, which is an examination of the large intestine.  An "esophageal capsule" is FDA approved but is not used at our facility at this time.  A "colon capsule" is in development and may in the future provide an alternative to colonoscopy.

Additional Resources

Small Bowel Capsule Endoscopy test brochure, from Given Imaging.
Understanding Capsule Endoscopy, from the American Society for Gastrointestinal Endoscopy.

Colorado Payer Fact Sheet for PillCam Capsule Endoscopy.  This information is provided for use by referring physicians considering direct referral of a patient to Digestive Health for capsule endoscopy.