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Modern endoscopic techniques have revolutionized the diagnosis and treatment of diseases of the upper gastrointestinal tract (esophagus, stomach, and duodenum) and the colon. The last remaining frontier has been the small intestine.
The small intestine has been a difficult organ in which to make diagnoses and treat without performing surgery. Radiological procedures, specifically the upper GI series with small bowel follow-through, which involves following swallowed barium as it passes through the intestine with x-ray films, have been available for diagnosis, but these radiological procedures are time-consuming and are not accurate in identifying small tumors and other subtle abnormalities of the small intestine. The demand for improved capabilities in the small intestine has been less because a minority of intestinal diseases involve the small intestine beyond the reach of the upper gastrointestinal endoscope and the colonoscope. Nevertheless, improved diagnostic and therapeutic capabilities in the small intestine would be very useful, particularly in uncovering the causes of abdominal pain, diarrhea, and anemia due to intestinal loss of blood and diagnosing diseases that may involve only the small intestine, for example, Crohn's disease. One of the newer technologies that expands the diagnostic capabilities in the small intestine is capsule endoscopy also known as wireless capsule endoscopy.
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What is capsule endoscopy?
Capsule endoscopy is a technology that uses a swallowed video capsule to take photographs of the inside of the esophagus, stomach, and small intestine. For capsule endoscopy, the intestines are first cleared of residual food and bacterial debris with the use of laxatives and/or purges very similar to the laxatives and purges used before colonoscopy. A large capsule-larger than the largest pill-is swallowed by the patient. The capsule contains one or two video chips (cameras), a light bulb, a battery, and a radio transmitter. As the capsule travels through the esophagus, stomach, and small intestine, it takes photographs rapidly. The photographs are transmitted by the radio transmitter to a small receiver that is worn on the waist of the patient who is undergoing the capsule endoscopy. At the end of the procedure, approximately 8 hours later, the photographs are downloaded from the receiver into a computer, and the images are reviewed by a physician. The capsule is passed by the patient into the toilet and flushed away. There is no need to retrieve the capsule!
What are the limitations of capsule endoscopy?
While the capsule provides the best means of viewing the inside of the small intestine, there are many inherent limitations and problems with its use, the most important of which is that the capsule does not allow for therapy. Other problems include:
- Abnormalities in some areas of the intestine are missed because of rapid transit of the capsule and blurred, uninterpretable photographs. The images can also be blurred by retained stool of food debris. Hence the importance of a good bowel preparation prior to the capsule endoscopy.
- At times, transit is so slow that the capsule examines only part of the small intestine before the battery fails. The battery life is about eight hours.
- If abnormalities are discovered that require surgical resection or further investigation, it may be difficult to determine where in the small intestine the abnormality is and thereby help direct therapy.
- If there are narrow areas due to scarring (strictures) or tumors in the small intestine, the capsule can get stuck in the narrow area and cause an obstruction of the intestine that requires surgical removal of the capsule. (For this reason, in patients who are suspected of having a stricture, a self-dissolving, dummy capsule is swallowed first. If the dummy capsule sticks, it can be seen on an x-ray of the abdomen and the location of the stricture determined. Because it dissolves with time, however, the obstruction from the capsule will resolve without surgery, and the real capsule will not be used.)
- Finally, reviewing the tens of thousands of photographs is very time consuming for the conscientious physician.
What type of diseases can be diagnosed with capsule endoscopy?
Capsule endoscopy continues to improve technically. It has revolutionized diagnosis by providing a sensitive (able to identify subtle abnormalities) and simple (non-invasive) means of examining the inside of the small intestine. Some common examples of small intestine diseases diagnosed by capsule endoscopy include:
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"Wireless video capsule endoscopy"
Uptodate. Updated July 16, 2016
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Abdominal Pain (Causes, Remedies, Treatment)
Abdominal pain can have many causes that range from mild to severe. Some of these causes include bloating, gas, colitis, endometriosis, food poisoning, GERD, IBS (irritable bowel syndrome), ovarian cysts, abdominal adhesions, diverticulitis, Crohn's disease, ulcerative colitis, gallbladder disease, liver disease, and cancers.
Signs and symptoms of the more serious causes include dehydration, bloody or black tarry stools, severe abdominal pain, pain with no urination or painful urination.
Treatment for abdominal pain depends upon the cause.
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased. There are several types of anemia such as iron deficiency anemia (the most common type), sickle cell anemia, vitamin B12 anemia, pernicious anemia, and aplastic anemia. Symptoms of anemia may include
- hair loss,
- menstruation, and
Treatment for anemia includes treating the underlying cause for the condition. Iron supplements, vitamin B12 injections, and certain medications may also be necessary.
Balloon EndoscopyBalloon endoscopy is a procedure to view the small intestine and the digestive track. There are two types of balloon endoscopy, single balloon and double balloon. Balloon endoscopy requires approximately one to three hours for the procedure. Balloon endoscopy is used to treat of diseases of the
- duodenum, and
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ColonoscopyA colonoscopy is a procedure whereby a docotor inserts a viewing tube (colonoscope) into the rectum for the purpose of inspecting the colon. Colonoscopy is the best method currently available to diagnose, detect, and treat abnormalities within the colon.
Crohn's DiseaseCrohn's disease is a chronic inflammatory disease, primarily involving the small and large intestine, but which can affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are common symptoms.
Indigestion (dyspepsia) can be caused by diseases or conditions that involve the gastrointestinal (GI) tract, and also by some diseases and conditions that do not involve the GI tract. Indigestion can be a chronic condition in which the symptoms fluctuate infrequency and intensity. Signs and symptoms that accompany indigestion include pain in the chest, upper abdominal pain, belching, nausea, bloating, abdominal distention, feeling full after eating only a small portion of food, and rarely, vomiting.
During pregnancy indigestion may become worse. Home remedies, medication, and lifestyle changes can help relieve and cure indigestion its symptoms.
EndoscopyEndoscopy is a broad term used to described examining the inside of the body using an lighted, flexible instrument called an endoscope. Endoscopy procedure is performed on a patient to examine the esophagus, stomach, and duodenum; and look for causes of symptoms such as:
- abdominal pain,
- difficulty swallowing, or
- intestinal bleeding.
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- abnormalities of the muscular wall of the GI tract.