Aids Diagnosis in Small Intestine
Feb 26, 2003
Patient Can Go to Work Even Eat with Device Inside Body
Like the film Fantastic Voyage, physicians at NewYork-Presbyterian Hospital Weill Cornell Medical Center can now take a journey through a patient's body. They aren't inside a miniaturized submarine but rather watching images taken by a tiny camera inside a pill-like device that is swallowed by the patient. The procedure, called capsule endoscopy, has proven to be effective in aiding diagnosis of previously undetectable abnormalities in the small intestine that commonly result in gastrointestinal bleeding.
Unexplained abdominal pain or bleeding, if left untreated, may be life-threatening and require hospitalization, said Dr. Felice Schnoll-Sussman, Assistant Professor of Medicine at Weill Cornell Medical College and Assistant Attending Physician at NewYork-Presbyterian Weill Cornell. In the past, diagnosis of a patient's small intestine was only possible with traditional endoscopy, small bowel x-rays, or open surgery. Capsule endoscopy is a much improved technique, allowing us to literally shed light on previously hidden areas of anatomy and it is exceptionally safe and convenient for the patient.
The FDA-approved device has been shown through numerous studies to be safe and effective. When administered, the capsule glides smoothly through the patient's digestive tract, is naturally excreted, and disposed of. The device, slightly larger than an antibiotic pill, contains a color-imaging camera, a transmitter, and four light-emitting diodes. The patient wears a data recorder around his waist; the recorder stores images that are later downloaded and viewed by the physician. While worn, the data recorder is inconspicuous enough to allow patients to continue everyday activities such as work, shopping, even eating.
Patients with severe small intestinal bleeding are often hospitalized and may require a blood transfusion. In order to determine the source of the bleeding, patients are commonly given a standard endoscopy and colonoscopy but these procedures will not reveal bleeding in the small intestine. Capsule endoscopy is a noninvasive and highly effective way to locate bleeding in the small intestine rapidly, allowing for a proper diagnosis and appropriate treatment.
As many as ten percent of gastrointestinal bleeding cases are thought to occur in the small intestine. Capsule endoscopy is especially useful when other methods of diagnosis are unable to detect an abnormality, such as a lesion in the intestinal wall. Another advantage to the non-invasive procedure is that it does not require anesthesia or a bowel preparation.
Dr. Schnoll-Sussman is currently enrolling patients for a study that will examine capsule endoscopy for the diagnosis of pre-cancerous growths in individuals with familial adenomatous polyposis, a genetic syndrome that carries an increased tendency towards polyp formation in the small bowel. Capsule endoscopy will be compared to a small bowel series, the more-commonly used radiological diagnostic method.
In a previous clinical trial, the capsule endoscopy imaging system detected physical abnormalities in 55 percent of patients compared with 30 percent for standard push enteroscopy, a procedure that involves a camera attached to a flexible wand that is inserted through the patient's mouth and guided into the small intestine.
The capsule, while ideally suited to the tight passages of the small intestine, is currently not effective for diagnosis in the stomach or large intestine. The device used is called the M2A, a patented technology from Given Imaging, Inc., of Norcross, Georgia. It received FDA approval in August 2001.