The capsule endoscopy  is a new procedure promising to show here to fore uncharted areas of the alimentary canal.  Up until recently there was only the endoscope to look inside the colon (colonoscopy), or the stomach or duodenum or small intestine.  Since the length of the scope is limited by how far you can successfully run the controls and pass the fiber optics, they are limited to about 36 inches.  With the adult small intestine being 23 feet long, you quickly run up against  the limitation of what you can observe.  Before the capsule endoscopy or pill endoscopy, if you wanted to look further down the or up the gut you would have to literally take it out and look at it.  Not a very comfortable solution for the patient.  Even with laproscopic procedures, you are placing the patient under dangerous general anesthesia, putting holes (small ones) in the body and disturbing an area of the body that really doesn't like to be disturbed that much.  Adhesions are just one of the complications that can be caused by invasive procedures into the abdomen.

Now you can just swallow a pill!  Admittedly, it's a pretty large pill.  However now the entire length of the small and large bowel can be visualized!  For people with chronic abdominal pain or other conditions, up until now, the small intestine was a black box into which no one could look.  The capsule passes through the intestines with little preparation, just a fast the morning before and maybe a laxative to make sure view is not blocked.  Patients with known swallowing problems, poor transit, strictures, or blockages may not be able to utilize this procedure.  If there is doubt, the patient can take a 'blank' or sugar pill of the same size as the camera capsule and see if it passes.  If it doesn't, it will dissolve by itself and pass in time.

The beauty of this thing is the incredible elegance of the pictures.  Before the pill endoscopy, the lumen of the intestine was inflated with air, but the pill just passes with water or the normal fluids of digestion.  In the picture above you can see the amazing structure of the wall of the small intestine.  The cilia are clearly visible like fingers in the river.  Pictures of regular endoscopic visualization only show  a glistening wall of mucus covered lining.  No floating, weightless fine structure.  Amazing.  To think that this little thing is going along taking pictures with a flash!  Ha ha ha, say cheese!  I wonder if you can see it when the lights are off?  Wouldn't it be great to swallow the pill with some food and watch it get dissolved?  How cool.

Of course the draw back to this system is that you cannot do anything while you are in there.  There is no way to steer the machine or manipulate tissue with it.  For instance, you can't ligate a polyp or cauterize a bleeding ulcer with it.  It just takes pictures for now.  I'm sure some smarty will eventually make something like a radio controlled submarine that has lasers and stuff on it...wait, i think they did that already but they didn't have remote control back then so they had to actually shrink a real submarine with real people down to fit inside a needle and they injected the guy with it... but they almost died, thank god they got out through the tear duct...or was that a movie, I forget....just kidding.  Ha ha.  That was "The Incredible Voyage".  What a great movie, eh?

Thanks for your attention.  If you have questions or comments about this entry or anything else on emergencydpt.com please feel free to contact me.

Best regards,
Spencer