New pill-size camera travels beyond other scope procedures to reveal gastrointestinal disorders in small intestines that often go unseen

Aug 9 2004

One pill, a glass of water and about eight hours is all it takes to produce nearly 60,000 high-resolution digital photos.

If it doesn't sound like your typical disposable camera, that's because it's not. And while this new camera is not designed to snap shots during vacations or at other special occasions, patients are finding that the latest in high-tech, digital photography is very easy to swallow.

Using this new non-invasive technology, known as a capsule endoscopy system, physicians at the University of Michigan Health System now have the ability to explore uncharted, and often unseen, territory within a patient's small intestines.

Capable of traveling beyond where other common scope procedures – upper gastrointestinal endoscopy or colonoscopy – leave off, capsule endoscopy is providing physicians with a clear view of obscure gastrointestinal disorders such as bleeding or Crohn's disease, which were previously difficult to visually detect. In more than two years, about 400 patients have used capsule endoscopy at UMHS.

“Capsule endoscopy is safe, easy and painless for patients, and it gives doctors very detailed information about the small intestines to make a diagnosis,” says Laurel R. Fisher, M.D., director of the Capsule Endoscopy Program at the U-M Health System. “This procedure is state-of-the-art, allowing us to see the small bowel like we never have before to offer hope to patients with otherwise undetectable gastrointestinal disorders.”

The high-tech diagnostic tool is utilized by Fisher and her colleagues in the U-M Gastroenterology Division when an upper gastrointestinal endoscopy and a colonoscopy are unable to detect the source for obscure bleeding or diagnose chronic or inflammatory diseases of the bowel, such as Crohn's, in a patient. Capsule endoscopy is designed for any patient aged 18 and over.

Patients like Nichole Layne were eager to try this new diagnostic tool, especially after learning how easy and painless the procedure is.

Layne, like all capsule endoscopy patients, arrived at U-M hospital's Medical Procedures Unit early in the morning to begin the test. Under the supervision of a physician, patients swallow pill-sized capsule with only a glass of water – no sedation for the test is required. A special coating surrounds the disposable capsule, allowing it to travel naturally, and undetected, down a patient's digestive tract.

From the teeth to the colon, the tiny capsule records its entire journey though the digestive tract – 25 feet in all – while closely examining the 15 to 18 feet of the small bowel.

Encased with a digital camera, light-emitting diodes, batteries and a transmitter, the capsule sends two images per second to sensors attached to the patient's torso. Those images are then transmitted to a Walkman-sized digital recording device strapped to the patient's waist.

Following the first two hours of the test, patients are able to drink fluids, and can even eat three to four hours into the test. Although patients do not need to check into the hospital for the test and can partake in everyday activities, Fisher, a clinical assistant professor in the Department of Internal Medicine at the U-M Medical School, says she requests that patients who undergo the test stay on hospital grounds in case they experience any problems with the equipment.

After about six to eight hours, the disposable capsule naturally passes through the patient's body, leaving Fisher and her colleagues with detailed images of the small intestines captured by the digital recording device. Patients do not need to return the disposable capsule.

The stored images are transferred to a computer and transformed into a digital movie. It takes gastroenterologists about 45 minutes to review the series of images. Those images can reveal other problems related to the small bowel, too, including vascular disorders, Celiac disease, and benign and malignant tumors.

Compared to the upper gastrointestinal endoscopy and colonoscopy she needed to undergo before doing the capsule endoscopy, Layne says the procedure was a “piece of cake” and “definitely worth the eight-hour wait at the hospital.”

While capsule endoscopy provides doctors detailed images of the gastrointestinal tract from mouth to rectum, Fisher says it should not replace regular colonoscopy procedures, which use a slim, flexible, lighted tube inserted through the rectum to examine the lining of the colon for abnormalities. Physicians recommend regular colonoscopies for patients over age 50.