(Updated Feb 2004. Original write up was in the
Q & A section)
The
camera pill is not intended to replace standard endoscopic
studies of the alimentary canal (oesophagus, stomach, small
and large intestine). In fact, the camera pill has not been
studied for use in the large intestine (colon) and is
currently unable to replace colonoscopy.
It is
not available in Malaysia currently. According to Professor
Dato’ Dr K.L Goh of University Malaya Medical Centre in
Kuala Lumpur, it is an expensive device and would probably
not be available in the near future. Before the device can
be adopted for standard use, many issues including
practicality would also have to be ironed out.
Brief Information on the Camera Pill
On 1st August 2001, the US Food and Drug
Administration cleared for marketing a small capsule-sized
camera (specifically the Given Diagnostic Imaging System)
that is intended for visualisation of the small bowel (small
intestine – the intestine between the stomach and the large
intestine/colon). This is the segment of bowel (except for
the most proximal, i.e. the duodenum) that the upper
oesophagogastroduodenoscopy cannot reach. The colonoscopy
only visualises the large bowel(colon) and at most, the
terminal bit of the small bowel.
Barium
studies (especially the small bowel enema) have thus far
been the mainstay of imaging the small intestine (bowel).
Barium studies are able to give motility information,
pattern of “distribution” in the abdominal cavity as well as
other signs such as narrowing (stricture), fistula (an
abnormal connection between one part of the small intestine
to another structure in the abdomen), thickening of the
bowel wall and growths within the intestinal wall. For
abnormal bleeding (for example from an abnormal blood
vessel) in this segment of the bowel, an angiogram (contrast
study of the blood vessels supplying the intestines) is
normally carried out. The other test is a special
radionuclide scan.
This
disposable camera pill is shaped just like a normal pill
capsule and contains a camera, transmitter, battery and a
light source. It is swallowed after an 8 hour fast and will
be propelled through the intestines by the normal
peristaltic waves. The patient can go home after taking the
“pill” but returns the next day to the hospital with the
data recorder. The cost of this camera pill is about the
cost of an endoscopic procedure in the USA.
The
camera pill is able to take pictures of the lining of the
small bowel as the pill passes through the small bowel.
These pictures are continuously transmitted to the receiver
(data recorder) that is in a belt worn round the waist of
the patient. The data is then downloaded to a computer for
analysis.
This
device (which runs on battery power that can last up to 8
hours) is for adding information and not replacing current
methods of evaluating the small intestine. It therefore acts
as a complementary procedure with specific indications as
decided by the physician/doctor. The camera pill cannot be
used in known or suspected intestinal obstructions, fistulas
or strictures. Patients with unexplained anaemia or blood in
their stool may be candidates for this if the usual
endoscopic or radiological examinations cannot diagnose the
problem.
The
advantages of the camera pill are that it is relatively low
risk for patients, “free” of radiation and there is minimal
patient discomfort.
Recent study shows usefulness of the
camera pill in small bowel disease
In a
report of a study in the January 2004 issue of the journal
Radiology, published by the Radiological Society of North
America, the digital video camera showed promise in the
diagnosis of small bowel disease. As expected when the
cameral pill was first announced several years ago, it is
able to demonstrate more abnormalities (such as ulcers,
tumours, vascular malformations) of the small bowel (25 feet
long) than any other small bowel imaging technique.
However, it is unable to tell the location of an abnormality
and capsule endoscopy as it is also termed may be more
useful when done in conjunction with a CT scan (computed
tomography). Those who may benefit from capsule endoscopy
include those with Crohn’s disease. Crohn’s disease is an
inflammatory bowel disease that commonly affects the small
bowel. In this Mayo study, data from patients who underwent
capsule endoscopy after a barium study or CT scan for
unexplained gastrointestinal bleeding, inflammatory bowel
disease or chronic abdominal pain were reviewed. |
