What is a capsule endoscopy?

Capsule endoscopy is a procedure where a pill-sized video capsule is swallowed to examine the small bowel. After swallowing the capsule, it travels through the gastrointestinal tract taking high-resolution pictures of the small bowel. The images obtained by the capsule are transmitted to a data-recorder worn in a harness around the waist. The procedure is a safe, non-invasive way to examine the small bowel, which is not easily reached by other imaging techniques such as gastroscopy and colonoscopy. 

How do I prepare for a capsule endoscopy?

To obtain a clear view of the small bowel it is important that the small bowel is clean of all faecal material. This is achieved by taking a short bowel preparation (i.e. one sachet of PicoPrep), modifying your diet and increasing your fluid intake. Your Gastroenterologist will provide you with specific instructions for the bowel preparation, which can be purchased from your local pharmacist.  The bowel preparation will flush out the small bowel resulting in diarrhoea. Patients taking diabetic medications should inform their Gastroenterologist as they may require specific instructions. 

How is a capsule endoscopy performed?

A belt containing a sensor will be wrapped around your waist and a satchel holding the data recorder worn over your shoulder. The capsule is then swallowed with a sip of water. Patients can then return home and gentle activity is encouraged to promote passage of the capsule through the small bowel (walking, driving, returning to work is permitted, avoid strenuous exercise, getting sensor/data recorder wet). Clear liquids can recommence 2 hours after the capsule is swallowed whilst solid food and medications are permitted 4 hours afterwards. 

You should NOT remove the belt at any time during the procedure. A blue light flashes on the top of the data recorder when the capsule is functioning normally and should be checked every 15 minutes – if the blue light stops flashing for several minutes, note the time and contact the rooms. Patients can remove the equipment themselves at home at 10pm and return the equipment to the rooms the next morning.

What happens after a capsule endoscopy?

The capsule usually travels through the entire small and large bowel within 1 to 3 days and will pass naturally in a bowel movement. Most likely you will be unaware of its passage. The capsule does not need to be retrieved and can be safely flushed down the toilet. An abdominal X-ray may be required to confirm complete passage if the capsule has not passed within 2 weeks. Until the capsule passes, any type of MRI scan should be avoided. Upon returning the sensor and data recorder to the rooms, the images from the data recorder will be downloaded and reviewed by your Gastroenterologist. 

What are the risks or side-effects?

Capsule endoscopy is a very safe procedure that carries minimal risk. However, in about 1% the capsule may have difficulty passing the small bowel. This can be due to a narrowing (stricture) in the small bowel due to inflammation, scarring from previous surgery or a tumour. Capsule retention is not usually serious in the short term, but if the capsule does not pass over time or if it causes pain or bowel obstruction then endoscopy or surgery may be required to remove it. Uncommon risks may include pain, nausea, missed pathology and incomplete small bowel examination due to slow bowel function or technical failure of the capsule equipment.