Test / Diagnostic Procedure: Video Capsule Endoscopy

Common reasons for performing a video capsule endoscopy include:

• Iron deficiency anaemia (lack of iron in the body)
• Unexplained bleeding from intestines that cannot be explained after examination of the stomach or colon
• Suspected coeliac disease or inflammatory bowel disease
• Abnormalities such as polyps (small growths), that have been seen on CT or MRI scans

Your doctor will explain why he/she has suggested a video capsule endoscopy.

Video capsule endoscopy involves swallowing a disposable capsule, roughly the size of a large vitamin capsule, with a drink of water containing a solution that dissolves any bubbles in the gut fluid. This capsule contains a camera, light source, battery and transmitter and travels naturally through the small intestine taking images of your gut as it does so. You will also be asked to wear a belt, containing sensors, which is attached to a data recorder that receives and stores the images from the capsule.

The test is usually started early in the morning and the equipment is worn throughout the day, during which you will be able to leave the unit and carry out your day as normal (although the equipment is visible).

You may drink clear fluids 2 hours and eat lunch 4 hours after swallowing the capsule. After about 8 hours you will to return to OneWelbeck were the equipment will be removed. The images are then downloaded onto a computer and will be reviewed by one of our highly experienced consultant gastroenterologists.

The capsule will ultimately be passed in your poo and it will flush away in the toilet. Usually you will not notice when you pass the capsule, but if you do see it this does not need to be returned.

A video capsule endoscopy is extremely safe and has few risks or complications, but these will be discussed with you before the day of your procedure. Occasionally it is necessary to swallow a ‘dummy’ capsule (also known as a ‘patency’ capsule to test whether the actual capsule can successfully travel through the small intestines). Further information will be provided if this is the case. If the dietary preparation has not worked and the bowel is not clean enough, the examination images may be inadequate, and the procedure may need repeating. Sometimes the intestines are slow and the capsule does not finish examining the small bowel during the procedure. This will show on the video and we will contact you to arrange an X-Ray within two weeks to see if the capsule is still in the body, although this usually confirms that the capsule has passed.

Occasionally, the capsule does not pass naturally and may become stuck in the gut. Often the capsule will pass after treatment with medication, but rarely it may require the use of an endoscope to retrieve the capsule. Alternatively, and very rarely, surgery may be required to remove the capsule and identify the cause of the capsule getting stuck. The signs of this are tummy pain, tummy cramps and vomiting. You will be given instructions about what to do in the rare event that this occurs.

There are very few reasons why we may not be able to perform the test, However, if you suspect you are pregnant or have an implanted cardiac device (this does not include pacemakers) please tell us as soon as possible as the procedure should not then be carried out.

Medication

One week prior to the examination: avoid iron supplements as these can stain the walls of the intestine and any fluid left in the small bowel, which would interfere with gaining a clear view. Nonsteroidal medications such as Neurofen or Ibuprofen can cause inflammation and ulceration in the small bowel and so should also be stopped.

Three days prior to the examination: Medications that slow down the bowel should be stopped. Also stop taking any bulk-forming laxatives (these include: Bran, Isphagula husk, Methylcellulose and Sterculia). All other medications can be taken as normal in the days prior to the examination.

Bowel Preparation

To get a clear view of the lining of the bowel, it must be empty and as clean as possible, so we recommend taking some bowel preparation the day before your test, in addition to some dietary restrictions. It is important to be near a toilet after taking the bowel preparation as you will experience some diarrhoea, which is normal.

The day before your video capsule endoscopy:

• Eat a light breakfast, such as egg on white bread toast.
• Eat a light lunch before 1pm and then no further solid food.
• Drink clear fluids only in the afternoon, aiming for one litre (4-5 regular glasses). This may include water, squash, fizzy drinks, clear strained soup or clear stock. You can drink tea or coffee without milk and it is best to avoid alcoholic drinks.
• At about 5pm make up one litre of MOVIPREP (mix sachet A and Sachet B into a jug + 1 litre of water). Drink over 1- 2 hours.

It is important to drink an additional 500mls of water or clear fluid during the evening.

The day of your appointment

On the day of the appointment essential medications can be taken with water before 6am. Non-essential medications can be postponed until you have a snack at lunchtime after swallowing the capsule– full instructions will be given. You may drink water up to three hours before your procedure, but do not have anything else to eat or drink until instructed at your appointment. This includes avoiding gum and sweets or mints. Please wear a loose top that buttons up or zips up at the front.

We will let you know when the results of your examination will be available. In most cases it will be necessary to make an appointment with the consultant who requested the test in order to discuss the results.