New Technology To Diagnose and Manage Small Bowel Disease
from Practice Update, Summer 2004
Figure 1: 1. Optical dome, 2. Lens holder, 3. Lens, 4. Light
emitting diodes 5. CMOS Semiconductor image, 6. Battery,
7. Transmitter, 8. Antenna
The Children’s Hospital has recently become one of only eight pediatric centers nationally to offer a new “camera pill” used to diagnose and manage diseases of the small bowel. The new technology allows for imaging of the small bowel surface in a way that was previously unattainable through other endoscopic techniques. Ed Hoffenberg, MD, Director of the Center for Pediatric Inflammatory Bowel Disease and associate professor of pediatrics at the University of Colorado Health Science Center explains, “We now have a tool to evaluate the entire small intestine. Previously, we were limited to scopes that view the upper gastrointestinal tract and colonoscopes to view the colon. With X-rays, CT scans, MRIs and barium studies, the information was difficult to obtain. These other procedures do not provide the mucosal detail now available through capsule endoscopy.”
Capsule endoscopy was approved for use in pediatric patients in October of 2003. With this approval, The Children’s Hospital Department of Gastroenterology now has the option of using the capsule to image the small bowel mucosa for diagnosing diseases of the small intestine.
Disorders That May Affect the Small Intestine Include:
- Obscure gastrointestinal bleeding
- Inflammatory bowel diseases including
- Ulcerative colitis
- Irritable bowel syndrome
- Iron deficiency anemia
- Malabsorptive diseases
The capsule, also know as M2A® technology can potentially be used in the diagnosis, staging and management of small intestinal disorders such as Crohn’s disease. Pediatric gastroenterologists are also able to use the M2A prior to surgery in an effort to further justify the need for a more invasive procedure and devise a plan for surgery. As the capsule provides a view of the entire small bowel, it may enable the physician to identify additional complications before the procedure, as well as the exact location of concern in the small intestine.
The flashing “camera pill” is made by Given Diagnostic Imaging and is the size of a large vitamin. Capsule endoscopy (CE) displays the small bowel’s entire length as the intestine moves the “camera” forward. Dr. Hoffenberg explains, “The camera pill is great for children with signs of occult bleeding Crohn’s, when you know something is going on. These patients can simply swallow a pill that will work its way through the small intestine and takes 55,000 images in the process.”
Figure 2: Rapid 2.0 Main Screen (1) Suspected Blood Indicator,
(2) Time bar, (3) Locator, (4) Thumbnail, (5) Transit time. Photos
complements of Given Imaging.
Imaging begins when the battery is activated. The process generally takes eight hours in adults and often less time in children. The pill passes naturally in a bowel movement. Actual size of the “camera pill” is 11mm x 26mm and weighs less than 4 grams. It contains a field view of 140 degrees and provides a detection of objects at a minimum of 0.1mm.
At The Children’s Hospital the entire “camera pill” process takes around eight hours. The patient comes to the hospital early in the morning after an overnight fast and only clear liquids after lunch the day before. On the day of the procedure, the patient will swallow the pill in the morning. At this time, they are also fitted with a vest to carry a data recorder and a series of sensors that are attached outside of the body. The sensors track the camera as it moves through the body and sends radiofrequency signals with images to the data recorder (Figure 3). “The great thing about the camera pill is children can go about their normal activities, while the test is being conducted,” Dr. Hoffenberg said. At the end of the day, patients return to Children’s to remove the data recorder and for the images to be downloaded to computer.
Figure 3. Photos from camera pill– mouth to cecum
Images from the data recorder can be downloaded in less than two hours and provide 55,000 images that can be played like a movie. Once the images have been downloaded, the specialist is able to review the diagnostic information. What was previously visible only by surgery can now be viewed in its entirety through the downloaded images. The Given System includes labeled anatomical landmarks, a capsule timebar, gastric and small bowel transit times, and a localization model with graphical representation of the M2A path (Figure 2). Collecting this data enables the GI specialist to approximate the location of a particular finding. In addition, the “Suspected Blood Indicator” scans the entire set of images for blood. The system will mark the spot(s) blood is found in the small intestine and allow the physician to go directly to that place in the film.
Contraindications of CE Include:
- Known or suspected gastrointestinal obstruction
- Strictures or fistulas based on clinical findings or pre-procedure testing
- If the patient has a swallowing disorder
- If the patient has a cardiac pacemaker
The M2A has been approved for imaging of the small bowel in children ages 10-18. Hopes for the future include development of the technology for imaging of the colon. In addition, Dr. Hoffenberg explains, “With this exciting new technology we are optimistic that we will be better able to manage chronic small bowel disease. The camera pill gives useful information that could only be obtained through surgery before.”
Information for this article has been adapted from: www.givenimaging.com
Seidman EG. Wireless capsule video-endoscopy: an odyssey beyond the end of the scope. Journal of Pediatric Gastroenterology and Nutrition. 2002; 34(4):333-4.
Appleyard M, Glukhovsky A, Swain P. Wireless-capsule diagnostic endoscopy for recurrent small-bowel bleeding. New England Journal of Medicine. 2001; 344(3):232-3
Pennazio M et al. Outcome of patients with obscuregastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. Gastroenterology. 2004; 126:643-53.
