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11/01/2002

Endoscopy: No Longer A Bitter Pill to Swallow
Dori Rogers, RN, BS, CCRN
Masthead Date October 09, 2001

"Endoscopy, no way!" How many times have we heard a patient, family member, or friend express dread at the prospect of this diagnostic procedure? Good news is on the way.

A camera in a capsule, called the M2ATM Swallowable Imaging Capsule, has been developed to diagnose pathologies of the small intestine. As of August 1, 2001, the capsule was approved by the FDA for use in diagnosing disorders in the small intestine.

Offers the Ability to Explore
Gastroenterologists will now be able to get a good look at the small intestine in its entirety. The small intestine of the gastrointestinal tract is the most difficult to examine. The length (11 to 25 feet) and configuration of the small bowel, with its complex twists and turns, adds to the limitations of conventional diagnostic studies.1 Often, patients must undergo testing beyond endoscopy to uncover GI bleeding, tumors, or lesions. Other diagnostic measures, such as barium x-ray procedures, CT scan, or MRI may be employed, but can be costly and time consuming.

Better than the Alternatives
Traditional fiberoptic endoscopy, sometimes called "push enteroscopy," uses a flexible cable to visualize the GI tract. This method not only causes discomfort for the patient, but can also cause perforation of soft tissue and hemorrhage. To enhance patient comfort and cooperation, sedatives and analgesics are administered. Reactions to medications used for sedation are rare, but they can and do occur.

A rarely used procedure called Sonde endoscopy, or "pull enteroscopy," has the potential to inspect all of the small intestine. The scope is introduced into the GI tract and is propelled by peristalsis into the large intestine. The gastroenterologist pulls back and views the small intestine for abnormalities. This procedure could take from six to eight hours with multiple adverse effects.

With both push and pull enteroscopy, patient anxiety and refusal of the procedures lead to undiagnosed, treatable conditions. Clearly the need for a pain-free and reliable means of viewing the small intestine is needed.

The new wireless capsule is 27mm long and 11mm in diameter. This is comparable in size to a large vitamin. The capsule contains a tiny color video camera, antenna, silver oxide batteries, video transmitter, and wide-angle lens. The disposable capsule is made of biocompatible material that is resistant to gastric secretions.

How It Works
The capsule is swallowed by the patient with a sip of water, then moves through the GI tract by peristalsis and is eliminated through normal evacuation. Images and tracking information are recorded by a receiving device or pack, which is worn around the patient's waist. Patients go about their daily routine and return the pack eight hours later. At the time of this writing, 20 human subjects have tested the M2A with no side effects, complications, or sensation of the capsule. No hospitalization or medical monitoring is required.

When the pack is returned to the provider, the information is downloaded to a computer workstation equipped with software, which processes the collected data and produces a video film of the small bowel. The pictures can be viewed frame-by-frame or in streaming video images with positional information. The specialist matches the image with the exact location of the abnormality. Pictures of the area can be printed for charting purposes or to be used in surgery.

Not for Everyone
Not all patients would be candidates for the M2A. Contraindications for its use are those persons with a history of major abdominal surgery, history of abdominal obstruction, patients with pacemakers or diabetes, and pregnant women.2

One limitation of the M2A is that the capsule can not be manually controlled for extended viewing of the intestinal wall. M2A cannot obtain tissue samples or remove polyps as in traditional endoscopy.

It is expected that the M2A will be comparable in cost to traditional endoscopic procedures. Good news for everyone.

Dori Rogers, RN, BS, CCRN, works as a registered nurse in the Interventional Radiology Department of St. Mary's Hospital, Waterbury, CT, and is completing a Master of Science degree in Nursing Education at the University of Hartford.

References

  1. Appleyard M, Glukhovsky A, Jacob H, et al. A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small bowel lesions. Gastroenterology. 2000;1431-1438.
  2. Blijdenstein E. Israelis ready to test "video pill." Popular Science. August, 2001.

From Nursing Spectrum - New England Edition. Copyright October 9, 2001.
All rights reserved. Used with permission.

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