Wireless Capsule Endoscopy (Pillcam)

Wireless Capsule Endoscopy (WCE) is a new and minimally invasive procedure to visualize the entire small intestine.

Common indications for capsule endoscopy include the evaluation of obscure gastrointestinal bleeding and suspected small bowel disease including Crohn's disease.

Your doctor may recommend a WCE to investigate your symptoms and determine the best course of treatment. This procedure involves swallowing a small capsule (the size of a jellybean) which will pass naturally through your digestive system while taking pictures of your intestine.

The capsule contains an imaging device and light-source on one-side and transmits images at a rate of two images per second for approximately eight hours, resulting in more than 50,000 images. The images are transmitted to a SensorBelt that is worn around on your stomach over a single layer of natural fibre clothing. The SensorBelt is connected to the walkman-like data recorder that is held in a pouch on a strap worn over the shoulder. The data recorder will save all the images. After about 8-9 hours the data recorder and SensorBelt will be taken off for processing.

How to prepare

Your stomach and small bowel must be cleansed by drinking Klean-Prep. This is to ensure the doctors get the clearest view possible of your small bowel. Be aware, therefore, that Klean-Prep will induce diarrhoea.

If you have diabetes please inform us as you may require special instructions regarding your diet and diabetic medications.

Stop taking iron tablets 5-7 days before the test.

Please follow these instructions, starting the day before your appointment:

  1. Have a normal sized breakfast.
  2. Eat a light lunch. Do not eat after 12 midday. You may drink clear fluids (water, black tea/coffee without sugar).
  3. Reconstitute Klean-Prep at midday. Dissolve the contents of the sachets in 2 litres of tap water and refrigerate.
  4. Start drinking Klean-Prep between 5-7pm. You should drink 1 glass every 5-10 mins, aiming to complete 2 litres over two hours. Feelings of bloating or nausea may occur after the first few glasses of Klean-Prep. Slowing the rate of drinking can decrease any nausea. Nausea should resolve after the bowel motions begin.
  5. Keep warm while you are drinking Klean-Prep.
  6. Drink unsweetened clear drinks during or after drinking the Klean-Prep to prevent dehydration. Drinks should be warm or hot if you feel cold.
  7. Do not drink after 12 midnight the night before the procedure.
  8. Important medications may be taken up to 2 hours before your appointment time, with a mouthful of water, or 4 hours after swallowing the capsule.
  9. If you suffer from angina or asthma please bring your GTN spray or inhalers with you. If you are an insulin-dependent diabetic, please bring your insulin.

You should wear a close fitting singlet or undergarment that covers your abdomen. The SensorBelt is fitted tightly over the singlet/undergarment. You should wear loose fitting, comfortable clothing to your appointment. (A large top and elasticated waist trousers are ideal. Dresses are unsuitable).

What can I expect to happen?

Before the Procedure

You should arrive at Auckland Gastroenterology Associates in the Mercy Specialist Centre by 7.30am on the morning of your procedure. Before the examination you will be asked questions about your general health and about any medications you take. If you take several, it is useful to bring a list of these with you. A doctor or nurse will answer any questions you have.

You may be asked to take a Metoclopramide tablet shortly after arrival. Metoclopramide hastens gastric emptying and facilitates examination of the whole small intestine.

The SensorBelt will be strapped to your abdomen and it will be connected to the data recorder which is held in a pouch will be worn on a belt over your shoulder. You will then swallow the capsule with a small amount of water containing Simethicone to reduce air bubbles.

During the Procedure

The capsule endoscopy procedure will last 8-9 hours during which time you will leave the Mercy Specialist Centre.

After swallowing the capsule, do not eat or drink anything for 2 hours. After 2 hours you may drink a small glass of water. After 4 hours you may have a light lunch.

After ingesting the capsule and until it is excreted, you should not go near any source of powerful electromagnetic field such as one created near a MRI (Magnetic Scanner) device at a Hospital.

Avoid any strenuous physical activity. Do not bend or stoop during the capsule endoscopy.

Do not remove the belt at any time during this period.

Every 15 minutes during the day you will need to verify that the small blue light on top of the data recorder is blinking. If for some reason it stops, it is likely that the battery pack will need replacing. Please record the time and contact Auckland Gastroenterology Associates.

The data recorder holds the images of your examination. Therefore you need to handle all the equipment carefully. Do not expose them to shock, vibration or direct sunlight, which may result in loss of important information.

After the Procedure

You will return to Auckland Gastroenterology Associates at 4.30pm. The data recorder and SensorBelt will be removed, and the information that you have recorded in the diary will be discussed.

You may then eat and drink normally. The capsule is disposable and it will be excreted naturally in your bowel movement.

Possible complications of Wireless Capsule Endoscopy

There is a very small risk that the capsule could get stuck in a previously unsuspected stricture or narrowing and cause an obstruction of the bowel. This is extremely unlikely to occur as most people coming forward for wireless capsule endoscopy have already undergone numerous bowel investigations, which would show up any such strictures within the bowel. In some instances a patency capsule test will be undertaken to exclude a significant small bowel stricture prior the WCE.

You should not have a capsule endoscopy if you have any of the following:

  • A known stricture (narrowing) of the bowel
  • Gastrointestinal fistulae or known large diverticulae
  • Please inform the doctor if you have a pacemaker or other implanted electrical devices as special precautions may be required