Capsule endoscopy is a camera that is swallowed to examine the small intestine. It is recommended for patients with obscure gastrointestinal bleeding, iron deficiency anemia, Celiac disease, and Crohn’s disease . It is usually done after an upper endoscopy and a colonoscopy.
The most important aspect of a good small bowel exam with capsule endoscopy is a clean small bowel. If there is dark fluid or debris left behind after bowel prep for a colonoscopy, your doctor can wash and suction it clean during your procedure. With capsule endoscopy of the small bowel we don’t have this luxury. It’s up to you, the patient, to give us the cleanest small bowel you can so your physician has the best chance of giving you a good exam.
How to Prep for Capsule Endoscopy
Cleaning the small bowel out isn’t as difficult as cleaning out the colon. Material in the small bowel is liquid and flushes out easier. Because of this, the prep for your small bowel exam isn’t as rigorous as it is for colonoscopy. There are several methods that work but I will discuss the one I have found to be most effective and easiest.
The Steps to follow
- The day before your scheduled small bowel exam begin a liquid diet after your morning meal. I cannot stress enough the importance of drinking plenty of fluids as it helps flush the small bowel and keeps you hydrated.
- Avoid fluids that are dark, red, blue or green as these can be hard to see through if still present in the bowel during your exam.
- Purchase the medium size bottle of Miralax (238 grams) or the generic equivalent.
- Divide the contents in half and put each half in a 20 oz. or more glass of water. The night before your exam, drink one of those glasses of Miralax a couple hours before bed. You can continue to drink clear liquids up until you go to bed. The next morning, 2 hours before you are scheduled for your small bowel exam, drink the second glass of Miralax.
- Continue to drink water only; up until you arrive at your doctor’s office for the exam. I encourage my patients to continue to drink water at this point as water filled small bowel is easier to see on the camera than a dry small bowel. Once at your doctor’s office you will swallow the capsule endoscopy. I encourage you to continue to drink some water even after you swallow the camera as it will help propel the camera along and again, gives a water filled small bowel that helps your physician see.
- You do not need to hold any of your blood thinner or aspirin-like medications. Avoid iron tablets for 5-7 days before the exam as they can make the lining of the small bowel dark and difficult to see through.
What to expect during capsule endoscopy
A sensor device is applied to your belly. The pill-sized capsule is swallowed and passes naturally through your digestive tract. The camera transmits video images to a data recorder worn on your belt for about eight to ten hours. At the end of the test, you will return to the office and the data recorder is removed so that images of your small bowel can be downloaded unto a computer for your doctor to review.
The capsule endoscope is about the size of a large pill. After swallowing the capsule and until it is excreted you should not be near an MRI device or schedule an MRI examination. Your doctor does not need the capsule that comes out with your stool. You may see a flashing object in the toilet bowl.
What happens after the capsule endoscopy
You can drink clear liquids two hours after swallowing the capsule. A light meal four hours after swallowing the capsule is allowed unless your doctor tells you something different. Avoid vigorous physical activity such as running or jumping during the study.
Your result is available after your doctor reviews the video and images. Expect your results within 1 -2 weeks following the test.
What are the possible complications of capsule endoscopy?
Small bowel capsule endoscopy is a very safe procedure. But like every procedure, there are potential risks and complications.
Electromagnetic device can interfere with the test. If you have a pacemaker, defibrillator, TENS unit, spinal cord stimulators and pain pump pump, let your doctor know.
One other possible complication is retention of the camera. This can happen if it gets stuck behind a tumor or stricture. It may be removed by an upper endoscopy or colonoscopy but sometimes surgery is required.
If you have Crohn’s disease your risk for camera retention may be a higher. For patients with suspected narrowing of the bowel, a soluble patency capsule (dummy capsule) can be given first. It can be ingested to help confirm if your small bowel is patent prior to swallowing the real camera. If the dummy capsule gets stuck, it dissolves.
When to call your doctor immediately
if you develop a fever after the test, have trouble swallowing or experience chest pain, tell your doctor immediately.
Also, if you develop unusual bloating, abdominal pain, nausea or vomiting. You should call your doctor immediately as these may be signs of obstruction.
Russell Dean Havranek, MD contributed to this article.