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Wireless Capsule Endoscopy (WCE)
Wireless capsule endoscopy using PillCam SB capsule was approved by the U.S. Food and Drug Administration in 2001. It was the first digital imaging device for the small intestine that provided direct high-resolution images of the mucosa.
Advantages:
Discuss the components of a capsule endoscope?
It contains an imaging device and light-source on one-side and transmits images at a rate of 2 images per second generating more than 50,000 pictures over an 8-hour period.
How is capsule endoscopy performed?
Discuss the effectiveness of WCE over other methods of investigating small bowel?
Summary of Incremental Yield (IY) of WCE over other modalities for suspected or diagnosed Crohn’s disease.
Ref: Triester SL, et al Am J Gastroenterol 2006
Discuss the indications of WCE?
Discuss capsule retention?
Capsule retention is defined as having a capsule remain in the digestive tract for more than two weeks.
Retention has been reported at ~ 0.75% overall or up to 13% in patients with known strictures (ref- Signorelli C, et al. Digestive and Liver Disease 2006 )
The published incidence of capsule retention varies with the risk being related to the indication: (Ref- Lewis B, Endoscopy 2005)
What are the causes of capsule retention?
Causes of retention cited in the literature include:
Capsule retention has not been reported in “normal” anatomy or anatomical variants (e.g., colon or small bowel diverticulosis and appendiceal orifices).
How do you treat capsule retention?
Capsule retention is managed by medical (steroid may improve strictures), surgical, or endoscopic intervention (using a balloon enteroscope)
Can capsule retention be prevented?
However, capsule retention can be prevented by using a patency capsule
Discuss patency capsule?
The patency capsule is a simple and convenient accessory to video capsules that is intended to verify functional patency of the GI tract in patients with known or suspected strictures prior to administration of the video capsule.
A patency capsule stays intact for minimum 30 hours post-ingestion. It subsequently disintegrates and is excreted. It emits electromagnetic waves at 64 KHz when sensing electromagnetic waves at 128 KHz.
Procedure:
Day 1: Patient swallows the patency capsule
Day 2: The patient’s abdomen is scanned using a hand held patency scanner. Patency is proven if the capsule is not detected by the patency scanner.
What are the contraindications of WCE?
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