Capsule Endoscopy: A Non-Invasive Alternative to Traditional Endoscopy

Capsule endoscopy may be used to detect conditions that traditional diagnostic methods often miss, particularly in the small intestine, which is a notoriously difficult area to examine comprehensively.

Conditions that may be diagnosed with capsule endoscopy include:

• Inflammatory Bowel Disease (IBD): IBD encompasses chronic inflammatory conditions affecting the digestive tract, with Crohn's disease being the most common. Capsule endoscopy reveals inflammatory patterns, ulcerations, and structural changes throughout the small bowel.
• Gastrointestinal Bleeding: Gastrointestinal bleeding is a condition where bleeding occurs anywhere along the digestive tract. Capsule endoscopy can detect active bleeding, blood clots, and vascular abnormalities throughout the entire digestive tract.
• Celiac Disease: Celiac disease is a type of autoimmune disorder that is typically triggered by the ingestion of gluten. The symptoms are unpredictable, as they can range from sharp cramps and diarrhoea to depression, infertility, and joint pain. Capsule endoscopy can help diagnose the disease, especially if a patient cannot undergo a traditional endoscopy for a duodenal biopsy or if their diagnosis is uncertain.
• Ulcerative Colitis: Ulcerative colitis is a chronic inflammatory condition that affects the colon. It causes the inner lining of the colon to become inflamed and develop small open sores or ulcers. Capsule endoscopy can help differentiate between ulcerative colitis and Crohn’s disease, as they share the same symptoms.

While traditional endoscopy remains vital in gastroenterology, capsule endoscopy offers a modern, non-invasive alternative. These procedures differ in:

• Invasiveness: Traditional endoscopy requires inserting flexible tubes through natural body openings. This invasive approach necessitates sedation, carries perforation risks, and requires recovery time. In contrast, capsule endoscopy is non-invasive. The patient simply swallows a small, pill-sized camera, avoiding the need for tubes or sedation.
• Areas Covered: Conventional endoscopy effectively examines the oesophagus, stomach, and duodenum (via upper endoscopy), and inspects the colon and terminal ileum (via colonoscopy). However, the middle portion of the small intestine often remains out of reach. Capsule endoscopy addresses this gap by offering enhanced visualisation of the entire small bowel.
• Procedure Experience: Traditional endoscopy may be associated with discomfort or anxiety due to the invasive nature of the procedure. Capsule endoscopy generally offers a more comfortable experience, allowing patients to go about most of their normal activities during the examination.
• Limitations: Traditional endoscopy allows for real-time intervention, such as tissue sampling, polyp removal, and bleeding control. In contrast, capsule endoscopy is purely diagnostic. If abnormalities are detected, follow-up procedures may be needed for treatment or biopsy. Capsule retention, though rare, is a known risk—particularly in individuals with strictures or previous abdominal surgeries.

Preparation typically begins the day before the procedure. Patients are often advised to consume only clear liquids and may be prescribed a laxative to empty the bowel. From 10 PM onwards, fasting is usually required, meaning no food or drink.

On the morning of the procedure, you must skip breakfast to ensure your stomach remains empty. Eating can typically resume a few hours after swallowing the capsule, though specific instructions may vary depending on the individual case.

Finally, it is vital to be completely honest about your medical history and all medications you are taking, as certain conditions or drugs can interfere with the capsule's ability to transmit data.

The procedure begins by attaching sensor patches to the patient’s torso. These sensors connect to a recording device worn on a belt. After setup, the patient swallows the capsule with water.

Inside the body, the capsule uses built-in lights and a miniature camera to capture thousands of images as it moves through the gastrointestinal tract. These are transmitted wirelessly to the recording device. The imaging frequency may adjust based on movement to ensure key areas are well-documented.

The procedure lasts around eight hours or until the capsule is naturally passed in the stool. Once complete, the images are downloaded and reviewed as a video for diagnostic analysis.

Most patients can resume regular activities immediately after swallowing the capsule. However, they must avoid removing the recording device or sensor patches until advised.

Dietary instructions will be provided—typically allowing clear liquids after a few hours and a light meal later in the day. Patients are generally advised to avoid strenuous activity and strong magnetic fields (such as MRI machines) until the capsule has passed.

If you experience nausea, vomiting, cramps, or severe abdominal pain, contact your doctor immediately.

The capsule usually passes within one to two days. If it has not passed within two weeks, follow-up imaging may be recommended. In cases of post-procedure constipation, increased fluids and fibre may help, though medical advice should be sought before using laxatives.

Capsule endoscopy is considered safe, but as with any procedure, there are potential risks:

• Capsule Retention: The capsule may become stuck in a narrowed area of the intestine, such as a stricture, polyp, inflammation, or tumour.
• Bowel Obstruction: In rare cases, a retained capsule may cause a blockage, which can lead to more serious complications if not addressed promptly.
• Swallowing Difficulties: Individuals with known swallowing issues may not be suitable candidates due to the risk of the capsule becoming lodged in the oesophagus.
• Interaction with Medical Devices: The capsule may interfere with implantable devices such as pacemakers, defibrillators, or neurostimulators. Patients should inform their medical team about any such devices prior to the procedure.