New Cancer Weapon: Can Camera Pill Replace Colonoscopy?

Anyone who has ever had a colonoscopy would be interested in hearing more about capsule endoscopy, a procedure that uses a tiny wireless camera to inspect the digestive tract.

Some of these devices are designed for the small intestine, some for the esophagus, and others for the colon. And while they may not yet entirely replace the need for colonoscopy — the standard procedure for detecting colon cancer — they are a great option for inspecting some portions of the intestinal system, experts say.

“They are very common and there are several different products on the market,” says Dr. Ethan I. Bortniker, assistant professor of medicine and director of Colorectal Clinical Research at the University of Connecticut Medical School.  “Capsule endoscopy for the esophagus and colon are interesting, but we have other, better, ways of diagnosing problems there.

“This is, however, one of the best ways to look at the small intestine. Our scopes can look at about 2.5 feet in a normal endoscopy, but the capsule can inspect up to 25 feet of the small intestine. Regular scopes can’t do that.”

The capsule, about the size of a vitamin pill, contains a small camera with its own light source. Patients swallow the pill and over a period of eight hours it takes multiple pictures of the digestive tract that are transmitted to an external device. Pictures are saved on a recorder and put together to create a video viewed by a physician after the procedure is over.

Capsule endoscopy poses few risks, and doesn’t require sedation, unless it becomes lodged in the intestines and causes an obstruction. Otherwise, it gives doctors a better look at the small intestine, which is hard to reach with normal scopes.

You can prepare for a capsule endoscopy of the small intestine by fasting for 12 hours, delaying medications, and then planning to take it easy for a day. If the camera is used in the colon, however, it can require twice the usual prep.

A key advantage of the pill camera is that it doesn’t require sedation, Bortniker explains. Unfortunately, the pill cam can’t do anything to remove polyps, so it isn’t as useful in the large colon.

“The esophagus pill cam doesn’t require sedation either,” Bortniker says, “but if you see something with the camera, there is no way to do anything about it.”

In a traditional colonoscopy, polyps are removed and biopsied, something that is impossible with the pill cam. Still the pill camera can be a useful diagnostic tool that is less invasive that conventional colonoscopy and endoscopic procedures.

“The pill cam is a great diagnostic procedure, Bortniker adds. “For instance, if you have iron deficiency anemia you can look for the source of blood loss in the small intestine. It can be very useful to diagnose things.”

Doctors also use the pill cam to look for inflammatory bowel disease (Crohn’s disease), Celiac disease, ulcers, and tumors of the small intestine.  Pill cams were approved by the U.S. Food and Drug Administration in 2001 and have been available for several years.

Because it is a relatively new diagnostic procedure, not all insurance companies will cover it.

“There are certain hoops you have to jump through to have this procedure,” Bortniker says. “It’s not the first GI test that we have to draw on.”

Things to consider if you are considering the use of the pill cam:

• Make sure your insurance company will cover the procedure.
• Let your doctor know if you have a pacemaker or defibrillator, if you have had abdominal surgery, or have a history of bowel obstructions.
• You will probably be advised to take it easy during the test – no running, jumping or vigorous exercise.
• Signs of bowel obstruction – unusual bloating, abdominal pain, nausea or vomiting – should be reported to your doctor immediately.
• Be careful not to disconnect the camera, which is attached to your abdomen with adhesive. Doing this might disrupt the process of taking pictures or delete important information.
• You should wait two hours after you have swallowed the pill cam before you have anything to drink. After four hours you might be allowed to have food.