Children’s First in Region to Offer Camera Pill

from The Children's Hospital (TCH) News, May 2004

The Children’s Hospital is the first pediatric center in the region to use a new "camera" pill to diagnose and manage Crohn’s disease and occult bleeding in children, said Ed Hoffenberg, MD, Director, Center for Pediatric Inflammatory Bowel Disease and associate professor of pediatrics at the University of Colorado Health Sciences Center.

Until March, Children’s doctors could not see the entire small bowel when evaluating children with these disorders of the small intestine. But thanks to the new pill, which received FDA clearance for use in children in October 2003, "We have a new tool to evaluate these diseases," Hoffenberg said. Children’s has been performing this test on a new patient every week or two.

Doctors often diagnose occult (fecal) bleeding or Crohn’s, a chronic medical condition characterized by inflammation of the bowel, with scopes to view the upper gastrointestinal tract and colonoscopies to view the colon, Hoffenberg said.

"Even with X-rays, CT scans, MRIs and barium scans, you can’t see the detail of the lining of the GI tract," he said. "The information was difficult to obtain."

The flashing pill, made by Given Diagnostic Imaging, is the size of a large vitamin, Hoffenberg said. Children with signs of occult bleeding or Crohn’s — "when you know something’s going on," Hoffenberg said — can now come to Children’s and simply swallow the pill, which works its way through the small intestine, taking 55,000 images along the way — a much less-invasive process than an X-ray or a CT scan. The process takes about eight hours for adults — often shorter for children, Hoffenberg said, after which the pill passes naturally and is thrown away.

The child need only be big enough to swallow the pill, which can be harder than it sounds, Hoffenberg said.

"One kid was pretty freaked out by the flashing light," he said. "But most kids take it just fine."

The pill sends a radiofrequency signal to a pager the child is given to carry, Hoffenberg said.

"The nice thing is, the kid can go to school," he said. The capsule also has no side effects, he said.

The child comes back at the end of the day, Hoffenberg said, and the images are downloaded on a computer and run "like a movie," he said.

The most common thing doctors see, he said, is Crohn’s. Doctors also can see areas of injury in the small bowel and the source of occult bleeding in detail.

"We can’t find where it’s from otherwise," he said. "Occasionally children have occult bleeding but we don’t know the source. The capsule will identify the small bowel source in about 70 percent of cases."

Children’s is one of just eight pediatric centers or children’s hospitals in the nation that offer capsule endoscopy to children. The other centers offering the camera pill are the Children’s Hospital of Boston, Children’s Medical Center-Dallas, Idaho Pediatric Gastroenterology, East Tennessee Children’s Hospital, Kaleida Health-Women’s and Children’s Hospital of Buffalo, Schneider Children’s Hospital (Hyde Park, N.Y.) and Children’s Healthcare of Atlanta.

In the future, Hoffenberg said, he hopes doctors can use the camera pill to see polyps in the small bowel or to check polyps’ progression or regression.

"We hope to study whether the capsule is useful in detecting graft-versus-host disease in BMT," he said.

He’s also hoping miniaturized capsules will be developed to make them less daunting for kids.

"We’re hoping to use the capsule to better define certain diseases and to learn whether the capsule will help us better manage chronic disease of the small bowel," he said. "The camera pill gives useful information that was difficult to obtain before."