Video Capsule Endoscopy

After an 8- to 12-hour fast, the patient swallows the video capsule, which peristalsis then carries through the gastrointestinal (GI) tract. The minuscule (11 × 30 mm) capsule contains a miniature complementary metal oxide silicon chip video camera, white light–emitting diode illumination sources, a power source, and a UHF (ultrahigh frequency) band radio telemetry transmitter (see the image below). Digital images of the GI tract mucosa are recorded at a rate of 2 frames/s and are transmitted via UHF band radio telemetry to a data recorder worn around the patient's waist.

Equipment for capsule endoscopy.

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Approximately 60,000 high-quality color images are recorded during each video capsule endoscopy (VCE) procedure. These images are compiled into a digital video (see the video below), which is then read at a workstation. Software detects video frames likely to contain blood and marks these for closer examination.^[8]For actively bleeding lesions, this software is highly accurate; however, it is less accurate for lesions that are not actively bleeding at the time of evaluation.^{[59, 66]}

Video of capsule endoscopy from patient with gastrointestinal bleeding.

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The camera lens has a short focal length that enables it to capture images as it passes the mucosa. At a magnification of 1:8, the capsule is able to detect lesions as small as 0.1 mm within a field of view as wide as 140º.^[6]The position of the capsule within the abdomen may be estimated to within 3 cm and is calculated on the basis of the strength of the signal detected by external sensors.^[8]

The patient may remain ambulatory for the procedure. In initial studies, the mean mouth-to-evacuation transit time was 24 hours.^[9]

For cases in which decreased stomach peristalsis prevents visualization of the entire small bowel with standard VCE, a method of delivering the capsule with an endoscope and a retrieval net has been described.^[67]

Complications

Few complications are associated with VCE. The most serious adverse event, capsule retention, is relatively uncommon (1-3%) but can have significant sequelae, including the need for emergency surgery.^{[68, 69, 70]}Capsule retention rarely produces symptoms.^{[5, 8]} The use of double-balloon enteroscopy to remove retained video capsules in the small bowel has been described.^[71]

In a review of 937 capsule endoscopies, no major complications were reported, and fewer than 1% of patients required surgical removal of the device.^[72]For capsules that may have been retained, an abdominal radiograph should be obtained. Several risk factors for capsule retention have been identified, including dysphagia, gastroparesis, previous abdominal irradiation, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), and small-bowel strictures from Crohn disease.^{[72, 6]}

To test for GI tract patency, a dissolvable capsule has been developed that can be administered before VCE. If the capsule is passed intact, no obstruction should be present; if the capsule is retained, it dissolves within 40 hours.^{[73, 6]}A study by Nemeth et al suggested that nonselective use of the patency capsule in patients with established Crohn disease may not significantly reduce video capsule retention.^[74]

A barium series before VCE may detect some strictures, though it may not be as sensitive for the detection of partial obstruction. Capsule retention is possible despite typical radiographic results on barium studies.^{[8, 6]}

Rebleeding is a possible complication as well.^{[75, 76]}

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Media Gallery

Equipment for capsule endoscopy.
Hemorrhagic telangiectasia.
Crohn disease, linear ulceration.
Celiac sprue.
Images may be recorded at any point after ingestion.
Video of capsule endoscopy from patient with gastrointestinal bleeding.

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Author

Ruben Peralta, MD, FACS, FCCM, FCCP Deputy Trauma Medical Director, Professor and Director of Trauma, Emergency and Critical Care Fellowship Program, Senior Consultant in Surgery, Trauma, Emergency and Critical Care Medicine, Associate Director of Trauma Intensive Care Unit, Hamad General Hospital and Hamad Medical Corporation, Weill Cornell Medical College in Qatar

Ruben Peralta, MD, FACS, FCCM, FCCP is a member of the following medical societies: American Association of Blood Banks, American College of Healthcare Executives, American College of Surgeons, American Medical Association, Association for Academic Surgery, Eastern Association for the Surgery of Trauma, Massachusetts Medical Society, Society of Critical Care Medicine, Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Fernando A Contreras Peña, MD Private Practice, Santo Domingo, Dominican Republic

Fernando A Contreras Peña, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

John Geibel, MD, MSc, DSc, AGAF Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, Professor, Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow; Fellow of the Royal Society of Medicine

John Geibel, MD, MSc, DSc, AGAF is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Additional Contributors

Brian J Daley, MD, MBA, FACS, FCCP, CNSC Professor and Program Director, Department of Surgery, Chief, Division of Trauma and Critical Care, University of Tennessee Health Science Center College of Medicine

Brian J Daley, MD, MBA, FACS, FCCP, CNSC is a member of the following medical societies: American Association for the Surgery of Trauma, Eastern Association for the Surgery of Trauma, Southern Surgical Association, American College of Chest Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Shock Society, Society of Critical Care Medicine, Southeastern Surgical Congress, Tennessee Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Sarah C Langenfeld, MD Assistant Professor, Department of Psychiatry, University of Massachusetts Medical School; Attending Psychiatrist, Community HealthLink

Sarah C Langenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Capsule Endoscopy Technique

Video Capsule Endoscopy

Complications

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