Capsule Endoscopy PillCam

As I briefly touched on in my more technology focused post about the PillCam I underwent capsule endoscopy in late 2018 to help diagnose my Crohn’s disease. This post is a break away from my usual tech focus and more for my fellow IBD sufferers who are perhaps considering or have been referred for a capsule endoscopy themselves.

I think a good starting point is address why capsule endoscopy is needed and the benefits it has over traditional colonoscopy / endoscopy; Those that have had a more traditional “probing” will know it’s incredible invasive and at times quite painful too! It also requires a whole host of people to be involved and is very time consuming, But the biggest factor is there is a limit to how “deep” a flexible endoscope can go, or to put it crudely if you did a simultaneous colonoscopy and endoscopy the two scopes would never see each other!

The limit is due to the small bowel which is tightly packed in the abdomen and roughly 3-5m in length, a flexible endoscope has a maximum penetration length of about 1.5m but of course (in the case of colonoscopy) you also have 1.5m of large bowel to pass through first and most scopes simply cannot articulate tightly enough to navigate though the small intestines.

So this is where capsule endoscopy comes in, it is basically a camera inside a pill that you swallow and it takes pictures as it goes! There is actually quite alot more to this and the software used to analyse the images contains some technical marvels itself being able to detect a host of problem from polyps to cancers.

Being referred to recieve a capsule endoscopy isn’t a ticket to being able to have the test done mind you, the first hurdle is a patency exam. The worse case scenario with a PillCam is that it becomes stuck, and as any IBD sufferer knows a bowel obstruction is a serious matter! As is such that before a capsule is called for a CT and/or MRI scan is done to check for any narrowing or diverticulitis that could trap the camera, the second line of defence is the patency capsule. This capsule is the same size & weight as the PillCam, but contains none of the electronic goodness, designed to test the camera itself will be able to pass.

The patency capsule is in fact quite interesting, it is designed to dissolve after 3p hours in the case that it does indeed get stuck being comprised of a lactose body, it also contains some barium which allows for it to be easily identified on an X-ray or CT scan.

Both the patency and PillCam procedures are very similar, turn up to the hospital in the morning and swallow it then your free to go about your day and confirm with the hospital when it ’emerges’ from the deep!

The major difference between the two though is with the PillCam you’ll also be fitted with a reciever, which is a harness that goes around the waist and up along the chest, it’s not constricting but also not flattering either. It goes over clothes so make sure to dress appropriately. The nurse will also show you how to safely remove it.

The receiver unit has a small screen which provides a live feed from the PillCam that the nurse will use to confirm the capsule has entered the bowels, in my case I had to do some walking around the hospital to motivate it! But once everything is working the screen & controls on the reciever are locked mainly to stop you playing with it but also to preserve battery power.

After the capsule has passed, you remove the reciever and harness and keep it safe as it will need to be returned the next day.

So I’m sure that anyone who has stumbled across this post from an internet search really wants to know the answer to two questions:

Does it hurt? Nope not in the slightest, on the grand schemes of things it’s barely even noticeable going in or out

I can’t swallow that, it’s huge! It does seem that way, I thought I was definitely going to choke on it and was hesitant getting it down but it is actually very easy to swallow, which when you think about it makes sense… it’s smaller than most mouthfuls of food swallowed when eating. If anything it’s got more of an illusion to it that because it’s a large pill it’s hard to swallow. Trust me it’s not, and I have an extreme hypersensitive pharyngeal reflex. The patency capsule is actually the worse of the two as it lacks the smooth surface of the PillCam that helps it glide down.

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