Is Capsule Endoscopy Right for You?

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    Recently, the U.S. FDA approved PillCam SB 3, an imaging capsule for endoscopy. PillCam SB 3 is swallowed by patients, and then it takes as many as 60,000 images before exiting the body. A sensor belt is strapped around a patient’s waist, with a data recorder in a pouch. This data recorder then stores all the images received by the sensors in real time.

     

    PillCam SB 3

     Photo: Given Imaging Ltd.

     

    The product is expected to be available in October and will mainly help people with small bowel abnormalities, such as Crohn’s disease. The images will help doctors track any irregularities or changes in a patient’s GI tract, including ulcers, bleeding, and lesions. 

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    According to Given Imaging Ltd., the inventor of the capsule, PillCam SB 3 weighs less than four grams and is about the size of a vitamin. PillCam SB 3 is the third generation of PillCam SB, which has been on the market since 2001 and administered to over a million patients.This procedure is less invasive than a traditional endoscopy, which comprises a doctor inserting a flexible tube with a camera on the end into the anus (colonoscopy) or esophagus (upper endoscopy) while the patient is sedated.

     

    There are several companies now producing imaging capsules for endoscopy. But which procedure is better: the traditional endoscopy or the capsule? Below is a breakdown of the two for you to compare, contrast, and decide for yourself.

     

    Capsule endoscopy

     

    Prep

    Begin fasting around midnight before the day of the procedure. Certain medications may be restricted in the days prior.

     

    Duration

    After ingesting the capsule and having the data recorder and belt set up, you may return home or to work. The capsule passes through the body cavity within 24 to 72 hours. After the capsule is exerted, you must return the belt and data recorder to the doctor, where the doctor will download the data and provide a diagnosis within 20 to 25 minutes.   

     

    Risks

    • Capsule retention, when the capsule stays in the digestive tract for more than two weeks
    •  Capsule aspiration, a rare but serious complication that involves the capsule going down the wrong pipe and into the airways instead of the esophagus
    •  Skin irritation, a low risk that results in mild redness and is treated topically

     

    Availability

    PillCam SB and other imaging capsules for endoscopy are already out there. But the question is whether your doctor uses this procedure and your insurance company covers it?

     

    Yuval Yanai, senior vice president and chief financial officer of Given Imaging Ltd., says the PillCam SB is used by roughly 3,000 gastroenterologists and is available to about 220 million Americans by various health insurance providers. However, The Boston Globe reported that despite capsule endoscopy becoming a widespread practice, many insurance companies won’t cover it unless a traditional endoscopy fails, which contradicts the point of taking a capsule instead. Check with your insurance company on their reimbursement policy.

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    Convenience

    Capsule endoscopy is minimally invasive. There is no sedation and almost zero recovery time.  You can continue daily activities during the procedure, while the capsule is in your system, but avoid intense physical activity.  

     

    One important factor to note is that biopsies can’t be performed with capsule endoscopy. So if the capsule detects something, an additional procedure via traditional endoscopy is required.

     

    Advantages

    The capsule allows doctors to see the entire small intestine, which can’t be done with traditional endoscopy. The capsule’s technology also provides more detailed images and tissue coverage. 

     

    Sources: American Society for Gastrointestinal Endoscopy; GivenImaging.com

     

    Conventional endoscopy

     

    Prep

    Begin fasting around six to 10 hours before procedure. For a colonoscopy, you must take several laxatives the day before to empty the colon. Your diet must be modified up to five days beforehand, eliminating small seeds, fiber and drinking only liquids.  Certain medications may be restricted in the days prior.   

     

    Duration

    An upper endoscopy usually lasts for about 20 minutes. A colonoscopy can last anywhere from 20 minutes to an hour.  However, you must stay for about an hour after the procedure ends as a precaution. Be aware the side effects of sedation can last for hours afterward. 

     

    Risks

    • Puncture of esophagus, stomach lining, colon or intestines 
    • Dehydration
    • Adverse reaction to sedation
    • Infection
    •  Bleeding

     

    Availability

    Traditional endoscopy is a common practice performed by almost every GI doctor. This is still the preferred procedure by most insurance companies, so reimbursement is more likely.

     

    Convenience

    For colonoscopy, the laxatives the night before can be a huge inconvenience because you must be near a restroom.  You may have to take a few days off from work for the procedure, depending on your prep and physical response to sedation.  As mentioned, the effects of sedation can lay someone out for the whole day, if not longer. You must have someone drive you afterward because operating a motorized vehicle is forbidden for the rest of the day.

     

    Advantages

    This procedure is a “one and done.” No returning to the office later or the following days. Also, a biopsy can be performed during a traditional endoscopy.

     

     

    Source: National Digestive Disease Information Clearinghouse (NDDIC)

     

    The Bottom Line

     Choosing between having a capsule endoscopy or traditional endoscopy is an important decision. There is no definitive answer as to which procedure is better. Think about what is best for you and your body. Be sure to discuss your options with your doctor and your insurance company.

     

Published On: August 26, 2013