Also known as video capsule endoscopy, capsule endoscopy is used to look at the inside lining of the small intestine. Conventional upper endoscopy will only visualize the beginning of the small intestine, and colonoscopy will only visualize the end of the small intestine. Capsule endoscopy is a way of bridging that gap.
Capsule endoscopy is a pill – 11 mm x 26 mm – roughly the size of a jelly bean. The capsule contains a small camera that takes approximately two pictures per second over a period of eight hours. In all, approximately 50,000 pictures are taken and transmitted to a recorder worn by your child on a belt during the eight hours. These pictures are then downloaded from the recorder overnight and the recorder apparatus is then removed.
The day prior to the capsule endoscopy, your child may eat regular food up until 12 pm. After this time, he or she will need to have a clear liquid diet that includes water, soda, apple juice, ice pops, Jell-O, or broth. Clear liquids mean anything that you can see through. Typically patients are also asked to use a mild bowel preparation to ensure that the capsule goes through the entire small bowel within eight hours.
On the day of the procedure, your child will come to our office to swallow the pill. There should be nothing else ingested that morning. The capsule should be passed naturally in your child’s bowel movement, and may take up to a week to pass. We ask that once the capsule is ingested, you screen your child’s stools in order to insure the capsule’s passage out of the body (there is no need to return the capsule).
Conventional endoscopy is considered an invasive procedure that requires general or moderate sedation. During an upper or lower endoscopy, the physician will take tissue samples called biopsies. Capsule endoscopy is done without anesthesia as a way to visualize the small intestine that cannot be reached by conventional upper endoscopy. A physician does not take any biopsy samples during capsule endoscopy.
There is a rare complication called capsule retention in which the capsule does not pass through the small bowel due to slow transit or a narrowing of the small bowel. Patients at risk are those with known Crohn’s disease, have used chronic non-steroidal anti-inflammatory drugs, or have had a previous abdominal surgery. This complication can potentially lead to small bowel obstruction and may need to be corrected surgically. A retained capsule does not always lead to small bowel obstruction or require surgery.
Small bowel imaging by a CT scan, upper Digestive Disorders series with small bowel follow through, or magnetic resonance enterography prior to performing a capsule endoscopy may be helpful in assessing the risk of a narrowed small bowel. However, these tests are not always reliable. Another option is to use a patency capsule (Agile capsule), which can pass through the small intestine as a camera pill would, but if there is an obstruction, the Agile capsule will begin to dissolve at about 30 hours after ingestion. The passage of a dissolved patency pill suggests a narrowing in the small intestine.
Our office will contact your insurance company for authorization prior to the procedure; however, authorization does not guarantee payment.
Robbyn E. Sockolow, MD
Director, Division of Pediatric Gastroenterology and Nutrition
Capsule Endoscopy, Constipation, Digestive Disorders, Inflammatory Bowel Disease Pediatric Nutritional Disorders, Nutrition, GERD, Gastrointestinal Disorders
Thomas Ciecierega, MD Director, Pediatric Motility Center Esophageal/Colonic/Anorectal Motility Testing, GERD, Feeding Problems, IBS, Eosinophilic Esophagitis, Constipation, Celiac Disease, ph Impedance Testing
Anil Kesavan, MD Pediatric Gastroenterology, Gastroesophageal Reflux Disease, Constipation, Inflammatory Bowel Disease, Celiac Disease, Short Bowel Syndrome, Childhood Obesity, Liver Disease, Pediatric Nutritional Disorders, Aerodigestive Disorders, Feeding Problem, Nutrition
Aliza Solomon, DO Pediatric Gastroenterology, Metabolism, Constipation, Inflammatory Bowel Disease, Celiac Disease, Gastroesophageal Reflux Disease
Division of Pediatric Gastroenterology and Nutrition
505 East 70th Street
Helmsley Medical Tower, 3rd Floor
New York, NY 10021
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