Capsule Endoscopy

What is capsule endoscopy?

Capsule endoscopy is a procedure that allows CHOC gastroenterologists to see parts of the small intestine that cannot be reached with traditional upper or lower endoscopes. Unlike traditional upper and lower endoscopies, capsule endoscopies cannot take tissue samples or biopsies.

A video capsule, typically the size of a large vitamin pill, is swallowed or placed in the intestine using an endoscope. The capsule passes through the intestine taking thousands of pictures that are sent to a special recorder and compiled into a video for the gastroenterologist to review.

Why is capsule endoscopy done?

A capsule endoscopy allows your child’s gastroenterologist to see inside the small intestine in areas that can be tough to see using an endoscope or other traditional imaging tests. The test can be used to diagnose or guide treatment for a variety of conditions, including:

• Unexplained gastrointestinal bleeding and/or anemia.
• Inflammatory bowel disease, specifically for the diagnosis or ongoing treatment of Crohn’s disease.
• Polyps
• Malabsorptive syndromes, including suspected or ongoing Celiac disease.

What are the limitations of capsule endoscopy?

It is not possible to obtain tissue samples or biopsies during a capsule endoscopy. Depending on the patient’s motility, sometimes the capsule can be retained (stuck) within the stomach during the entire study, or at the end of the study, it may still be travelling though the small intestine making it an incomplete study. Lesions also may be missed, which would require the doctor to do the study again.

What are the risks of the capsule endoscopy?

The risks involved with capsule endoscopy are low. Capsule retention (the capsule getting stuck) happens in about one out of every 1,000 patients. The pill may take up to two weeks to pass before intervention is needed, especially if the patient does not have any symptoms. Bowel obstruction is rare and would require surgery. Patients who have had a prior abdominal surgery, have Crohn’s disease or are suspected to have Crohn’s disease should have contrast imaging before the study, or a dissolvable patency capsule that helps the doctor check to see if the capsule endoscopy can pass through the patient.

Also, your child should not have an MRI unless they have had an abdominal X-ray to confirm that the capsule is out of the body, or have visually seen it pass.

How do I prepare my child for capsule endoscopy?

For children who will be swallowing the capsule, clear liquids and bowel preparation (similar to undergoing a colonoscopy) will be needed 24 hours leading up to the procedure to ensure the clearest images possible. The doctor may ask that your child not take certain medications prior to the procedure. It is important to discuss all medications (prescription and over-the-counter), vitamin supplements and herbal supplements your child takes in advance.

If your child will have the capsule inserted using an endoscope, there will be additional preparation required. Learn more about endoscopy.at CHOC.

What happens during the capsule endoscopy?

If your child is old enough or able to swallow pills, the pill camera is covered in a slippery coating that makes it easier to swallow. Once inside the body, the camera passes through the digestive tract, taking photos as it goes. The camera can record for up to eight to 12 hours.

During this time, your child is generally free to go about his or her normal activities except for physical activities. Your child’s doctor will provide instructions on what and how much the child can eat and drink while the capsule is traveling through the digestive system.

How does the capsule leave the body?

The capsule will make its way through the body and will eventually be eliminated through a bowel movement. There is no need to try to recover the capsule from the toilet, as it can be flushed away. Depending on your child’s intestinal transit time, this may take anywhere from one to three days and sometimes longer.

When will we get the results of the capsule endoscopy?

After your child’s recording device is dropped off, the study is downloaded by the medical staff. Once the images or video are downloaded, the gastroenterologist will review the study (which may take up to two weeks) and follow up with you about the results.