What is a Wireless Capsule Endoscopy?
A new camera is made to fit into a capsule which can be easily swallowed. It is not much larger than most treatments swallowed in capsule form. Once the capsule has been swallowed, it starts to transmit pictures of the lining of your bowel to a receiver strapped to the outside of your body. The capsule has its own lights to allow the camera to see the bowel wall. The tiny batteries which power the capsule last no more than eight hours which is usually enough time for the capsule to pass right through your small bowel and into the large or lower bowel (colon). Small abnormalities can often be seen by the capsule and transmitted by a wireless technique so that up to 55,000 pictures can be stored for later examination on a computer.
Why have a Wireless Capsule Endoscopy?
You have been advised to have a test called Wireless Capsule Endoscopy (WCE). You will probably have had many other tests already, often involving an endoscope. However, this test does not involve a long black flexible 'camera' such as those used to examine you during your previous investigations.
Is there any alternative to this test?
This test is an addition to many other tests to discover the cause of your problems. There are other ways of looking at your small bowel, but none of these are as effective or as comfortable as WCE. X-ray procedures such as barium follow through, small bowel enema and angiography have limited value and may have already been tried in your case. Long endoscopes can be passed into the small bowel (enteroscopy), but this is often uncomfortable and unhelpful as often only certain parts of the small bowel (duodenum, jejunum, and ileum), which is around a third of the small bowel, can be seen in this way. WCE has been shown to be more effective at detecting small bowel problems that have not been diagnosed by other investigations.
What do I have to do?
Please stop any iron tablets (e.g. ferrous sulphate), NSAIDS (non-steroidal anti- inflammatory drug) for two weeks before the procedure.
Please let us know beforehand if you have a heart pacemaker or if you have had any abdominal surgery in the past 12 months.
The day before your test:
Please ignore the instructions on the Bowel Preparation packet and follow instructions below.
What is Bowel Preparation used for?
Bowel preparation has various names/brands, it is a bowel cleansing agent that flushes everything out of your intestines (gut) so that it is completely clean and empty. You may have been given bowel preparation because you are going to have a Wireless Capsule Endoscopy procedure, and it is important to have a clean bowel to get the best results and the clearest pictures to help diagnosis.
Before you take bowel preparation, please advise us if you have any of the following:
- if you have any swallowing difficulties
- gut blockage or perforation
- ileus (loss of muscle action in the gut)
- retention of food in the stomach
- an ulcer in your gut
- any allergies to any of the ingredients in the moviprep
- toxic or ulcerative colitis (inflammation of the colon)
- difficulty in swallowing
- reflux oesophagitis
- if you are pregnant or breast feeding.
Your routine medication can be taken as normal but take it at least one hour before starting your bowel preparation. This is because if you take any medication by mouth while you are taking bowel preparation, it will probably be flushed out before it has time to work.
When to take bowel preparation
The day before the procedure, you may eat breakfast up to 12 noon. Do not eat any more food or drink anything with milk in until after your capsule endoscopy. You may continue to drink freely clear fluids including clear soup.
How to take bowel preparation
At
Mix the first sachet of your bowel preparation. Drink the full amount of preparation over the next hour or two, followed by at least another litre of clear fluid over the next two hours.
At
Mix the second sachet of bowel preparation. Drink the full amount over the next hour or so, followed by as much clear fluid as you wish. The preparation will cause forced diarrhoea. The effect should wear off over the next few hours and you should be 'safe' to go to bed.
You should stay near to toilet facilities throughout the period of preparation.
You may drink clear fluids at any time up until 6.00am on the morning of the capsule endoscopy i.e. squashes, cordials (avoid blackcurrant) but no drinks with 'bits' or milk in
What about side effects?
If you feel bloated or get stomach cramps, try taking the bowel preparation more slowly. A few people feel sick or are sick. Sometimes there is soreness around the anus (bottom). If you get one of these effects, it should pass quickly. Rarely, people are allergic to bowel preparation and may get an itchy skin rash (hives). If any other symptoms occur, please refer to your doctor.
If there are any abnormalities detected?
Should you develop any unexplained abdominal or stomach pain, nausea or vomiting, please contact us. If this occurs out of hours, contact your GP or the Accident & Emergency department.
Your results will be sent to your referring doctor.
How to store bowel preparation
Store the sachets in a dry place at room temperature. It is best to make up and use the solution as you need it. If there is any left after 12 hours, discard it. Keep all medicines away from children. Do not use after the expiry date on the pack.
On the day of the test:
Take essential medication with a sip of water two hours before your test. Wear an upper garment of thin, natural fiber such as a t-shirt that is long enough to reach at least hip level and will not move above the belt.
Arrive for your appointment at the scheduled time.
Please report to the Gastroenterology Day Unit (GDU) near Mary Garth Ward, you will be met by one of our nurses. At this point the nurse specialist will give you the opportunity to discuss and ask questions about the test before providing your informed consent.
The procedure
A belt will be placed around your waist. This belt contains sensors that transmit images to a data recorder placed in a pouch.
After swallowing the capsule, you may be asked to lie on your right side for a period of time to speed the capsule on its way.
Once we are happy that the capsule is in the small bowel you will be allowed to leave the department. Expect to be in the department for up to two hours.
What happens when I go home?
It is important that you do not eat or drink for two hours.
After two hours, you may have clear fluids (such as water, fruit squash and tea or coffee without milk).
After four hours, you may have a light snack and have free fluids.
After eight hours the belt and data recorder should be removed and packed.
You can eat and drink normally. You will be able to move around as normal but avoid strenuous exercise.
Be sure the sensor belt is tight at the waist; do not attach anything to it.
Check the blue flashing Data Recorder light regularly to be sure it is blinking twice per second. If it stops blinking or changes colour, note the time and contact us.
Do not disconnect the equipment or remove the Data Recorder at any time during the procedure.
Most patients pass the capsule within a few days. However, the time it takes to pass can vary from person to person. Do not worry if this takes some time.
Equipment Return
You will be given a box to return the equipment. Please return it to the Gastroenterology Nurse Office, near Adam Bede Ward, Cheverel Wing between the hours of 9.00am and 12.00pm the day after the procedure. It is important that the equipment is returned promptly. Handle the equipment with care without exposing them to shock, vibration or direct sunlight.
What is a retained capsule?
Occasionally the video capsule that you have swallowed can be stuck in the intestine and not pass through the system. This happens to 1 in every 25 people who have the test.
Why does it get stuck?
There may be a narrowing in the intestine that the capsule is too large to pass through. This can be due to a disease of the intestine or kinking of the bowel due to scar tissue from previous operations.
Can a retained capsule be prevented?
In theory, it should be possible to rule out any narrowed areas in the intestine using an x-ray test called 'small bowel follow through'. This test involves drinking a liquid called barium that shows up on x-ray. However, the test is not very good at picking up problems in the small intestine. More than half of the people who have experienced a retained capsule have had a barium x-ray beforehand that has not picked up the narrowing. Many hospitals now only recommend a barium x-ray before a capsule endoscopy if the patient has symptoms of blockages or has undergone previous operations on the abdomen.
What happens to a retained capsule?
If the capsule comes across a narrowed area that it cannot pass, it stays above the narrowing. It does not get stuck fast like a cork in a bottle, and it does not constitute an emergency-capsules have been retained for weeks or months without causing any problems.
How do I know whether the capsule has been retained?
You will not know whether the capsule has been retained or not, as a retained capsule does not cause any symptoms. The only way it is possible to know is if the capsule has reached the large bowel (or colon) by the end of the recording time. If so, it is most likely to pass without problem. Sometimes the capsule has not reached the end of the small intestine by the end of the recording time, and we may ask you to return to the hospital after seven to ten days for an x-ray of the abdomen to see if it is still present.
How do you remove a retained capsule?
If the capsule has become retained because of a narrowed area that is caused by inflammation, then by treating the inflammation the capsule can sometimes pass through. This can only be shown on repeated x-rays and can take some weeks. However, if the capsule is retained by a narrowing that is unlikely to pass, then a keyhole operation may be needed to remove it.
Is there a 'positive' side to having a retained capsule?
It is a nuisance and a cause of some concern to have a retained capsule. However, in most cases the narrowing that has held up the capsule has been the cause of the problem that the test was investigating. If the narrowing is so tight that a capsule cannot pass, before long food would also be getting blocked, and the retained capsule has highlighted the problem at an earlier and possibly more convenient time. In cases where the retained capsule is due to a tumour, detecting this earlier may be a blessing.
Who will tell me whether the capsule has been retained?
The doctor or specialist nurse reading the test will contact you with the result of the examination and will recommend that you return for an x-ray of the abdomen if there is any suspicion of a retained capsule.
In the meantime, it is important that you do not undergo a test called a 'magnetic resonance' or MRI scan, as the metal in the capsule can interfere with the test and could be harmful to you. Having an MRI while the capsule is in your body may result in serious damage to your intestinal tract.
Once the capsule has passed, this test is quite safe. A retained capsule will not interfere with pacemakers, mobile phones, wireless computer networks or shop anti theft devices. It will however, set off airport metal detectors.
Check List:
- Stop iron tablets and NSAID two weeks before the procedure.
- Please let us know beforehand if you have a pacemaker.
- If you have diabetes please contact the diabetes nurse on 024 7686 5210 or mobile: 07789946508 for further information and dietary advice before commencing your enclosed bowel preparation.
- You must not have an MRI scan.
- Nothing to eat or drink for two hours after the endoscopy capsule.
- Return the equipment to the Gastroenterology Nurses Office near Adam Bede Ward, between 9.00am to 12:00pm the day after the procedure.
Who can I contact if I have any questions?
Should you have any questions or need any advice, please do not hesitate to contact us:
Advanced Clinical Practitioner 02476153943 Joanne Leonard
Gastroenterology Nurse Specialists: 02476153943 Natalie Flowers and Saskia Cooper
Consultant Gastroenterologists:
Secretary to Dr Wood and Dr Beckley 02476865161 Secretary to Dr Raman, Dr Kathawala and Dr Asghar 02476865255 Secretary to Dr Sung and Dr Hossain 02476865151
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