Table of ContentsView AllTable of ContentsPurposeRisks and ContraindicationsBefore the TestDuring the TestAfter the TestResults
Table of ContentsView All
View All
Table of Contents
Purpose
Risks and Contraindications
Before the Test
During the Test
After the Test
Results
Capsule endoscopy is a diagnostic procedure in which you swallow a capsule-encased micro-camera so that images of your esophagus, stomach, andsmall intestinecan be taken as the device passes through your gastrointestinal (GI) tract. Traditionally, healthcare providers have usedendoscopy—a procedure in which a flexible scope is inserted down your throat—to diagnose upper GI disorders. But capsule endoscopy has gained favor as it can reach areas that the endoscopy cannot reach, including the entire length of the small intestine. It’s also painless, minimally invasive, and doesn’t require anesthesia.
Purpose of Test
Capsule endoscopy is used to examine parts of the GI tract that cannot be seen with other types of endoscopy.
The disposable capsule, often referred to as a “pill-cam,” is roughly the size of a large vitamin tablet, allowing it to navigate your GI tract better than a scope. Within the self-contained unit is a miniaturized video camera programmed to take between two and 18 images per second, which then ultimately get transmitted to sensor equipment. (A regular video camera shoots between 24 and 25 images per second.) Also housed within the unit is one or several tiny LED lights, a radio transmitter, and an eight-hour power source.
This test is typically used when a disease is suspected in the small intestine or to pinpoint the location of bleeding, inflammation, or damage.
Among some of the reasons why capsule endoscopy may be used:
Capsule endoscopy is typically used to investigate blood loss only after endoscopy orcolonoscopyfail to reveal the source of the bleed. Around 5% of unexplained bleeding episodes stem from the small intestines, most often from small vascular lesions known asangioectasias.
Unlike endoscopy or colonoscopy, which can be used to remove polyps (polypectomy), capsule endoscopy can only be used for visual diagnoses, not treatment.
Accuracy
When used to diagnose Crohn’s disease affecting the small intestine, capsule endoscopic is considered superior at detecting early inflammatory lesions compared to all other modalities.
Similarly, the same study suggests that capsule endoscopy is between 83% and 89% accurate in correctlydetecting celiac disease, although a biopsy is still needed for a definitive diagnosis.
However, because the camera is simply swallowed and allowed to make its way through your system on its own, this visualization technique is passive. Even if the procedure is more likely to spot an intestinal disorder, the image may be fleeting or obscured, which can affect the conclusions that can be drawn from the test.
How to Prepare for an Endoscopy
There is also a risk of bleeding, particularly if the capsule passes through an area where there is inflammation or tissue damage.
While bowel obstruction is rare with capsule endoscopy, an emollient purgative like polypropylene glycol may be used to ease the passage of the capsule if needed. Less commonly, a procedure known as double-balloon enteroscopy (in which two balloons alternately inflate and deflate) can gently compel the capsule past the site of obstruction. In rare cases, surgery may be required.
Capsule endoscopy is contraindicated in people with a known bowel obstruction. It should be used with caution in anyone who is at risk of an obstruction, including those with a swallowing disorder (dysphagia); who is pregnant; or who has a pacemaker or other implanted cardiac device.
Capsule endoscopy does not require anesthesia. That said, it requires many of the same preparations used for a traditional endoscopic procedure.
Timing
The capsule endoscopy procedure requires overnight fasting and, as such, is usually scheduled first thing in the morning. After the sensor equipment is applied and the pill-cam is swallowed, the imaging will continue automatically as you go about your day. The test is complete when you either evacuate the pill-cam in stool or after eight hours, whichever comes first.
Location
Capsule endoscopy can be performed at a gastroenterologist office, a gastroenterology procedure unit of a hospital, or an independent endoscopy center available in some cities.
What to Wear
Eight adhesive sensors will need to be placed on parts of your abdomen. To reduce sweat and make application easier, wear a light, untucked cotton T-shirt. As the sensors will transmit to a sensor belt or data recorder that you must wear around your waist (if not over your shoulder with a holster), choose a shirt that is long enough to reach at least hip level and will not ride up. Your outfit should be one you won’t need to change out of for at least eight hours, as the equipment must remain in place until the test is over.
Food and Drink
You will need to stop eating and drinking at least 12 hours before the procedure. This helps improve the image quality as the pill-cam makes its way through the digestive tract. Your instructions from your healthcare provider will have specific timings about when to stop eating and drinking.
Generally speaking, you will need to stop eating solid food the day before the test. Up until a certain time, you may still be allowed to consume liquids, such as water, coffee, tea broth, clear broth, clear soda, and gelatin. Avoid milk or any liquid or gelatin that is red or purple (this may register on camera as blood).
Some healthcare providers may instruct you to take 10 fluid ounces ofmagnesium citratethe day before. The over-the-counter product can help gently clear stools from the body.Be sure to get the light-colored (lemon-lime) formulation, rather than the red (cherry-flavored) one.
For at least 12 hours before you swallow the pill-cam, you will need to stop all fluids, including water. Other food restrictions should continue for the duration of the test.
Medications
Some medications will also need to be stopped before the capsule endoscopy procedure. Chief among these are iron supplements or any multivitamins containing iron. Iron can not only stain the walls of the intestines; it can make it far more difficult to pass the capsule.
As such, you will need to stop taking iron-containing supplements three to four days before the test. You may also be advised to avoid strenuous exercise a day in advance as it may slowperistalsis, the rhythmic contraction of gastrointestinal tissue.
Pepto-Bismol(bismuth subsalicylate) should also be stopped three or four days in advance because it can also affect peristalsis and leave black-colored deposits.
While blood thinners and aspirin are typically avoided prior to traditional endoscopy (due to the risk of bleeding), they pose no such risk for capsule endoscopy.
Finally, if you take chronic medications, you may need to delay doses until two hours after the pill-cam is swallowed. Speak with your healthcare provider to make the appropriate adjustments so that you don’t entirely miss your daily dose.
What to Bring
Be sure to bring your ID and health insurance card to your appointment. If you have to delay a medication dose and are not planning to return home after the test is started, be sure to bring the dose with you.
Cost and Health Insurance
Insurance pre-authorization is required for the test. Ultimately, the decision to authorize is based on the prescribed treatment guidelines and the associatedICD-11 diagnostic code. In some cases, capsule endoscopy may only be approved after traditional endoscopy has been performed.
Call your health insurance representative to understand what the guidelines dictate. If the procedure is denied, your healthcare provider may be able to provide additional information as to why the procedure to essential.
If you are uninsured or cannot afford thecopay or coinsurancecosts, shop around for the best price. Independent endoscopy centers may offer nominal savings. Ask if there are monthly payment options or a discount if the payment is made upfront.
Other Considerations
If you are especially hairy, you may be asked to shave parts of your chest and abdomen in order to affix the sensors. Doing so in advance will save you time at the healthcare provider’s office.
Though the equipment can be bulky and cumbersome, some people choose to work or continue their normal daily routine during the test. Others stay home. While the belt and data recorder are portable, they are not invisible.
Capsule endoscopy is a relatively straightforward procedure. The preparation takes place in the healthcare provider’s office or a procedure center. The remainder of the test continues as you go about your day.
Pre-Test
Once all the equipment is in place and checked out, you will swallow the pill-cam with a little water. (Its slippery outer coating helps it go down easy.) You shouldn’t be able to feel the pill-cam from then on.
All told, the preparations will take around 15 minutes, barring delays. You are then free to leave office, drive, and even return to work if appropriate. You must avoid strenuous physical activity and follow specific dietary guidelines throughout the day.
Throughout the Test
The actual imaging starts the moment you swallow the pill cam. The camera will “telecast” the images it takes to the sensors, and the signals will be delivered to the sensor belt or recording device (either wirelessly or via cables).
While instructions can vary, you will generally be able to resume any medications two hours into the test. You will also be allowed to consume clear liquids, including broth or a light-colored sports drink. After four hours, you will usually be permitted to have a light lunch or at least a snack. After that, your healthcare provider will ask you to continue a liquid diet until you either see the pill-cam in the toilet after a bowel movement or reach the eight-hour mark. When that happens, the test is over.
Post-Test
The pill-cam is disposable and can be flushed down the toilet. You can then remove the patches, belt, and data recorder.
It may take some people hours or days to evacuate the pill-cam; most people pass it in 24 to 72 hours. If you unable to spot the pill-cam in your stools after two weeks, call your healthcare provider. An X-ray may be needed to see if the device is stuck somewhere in your digestive tract.
Some people may experience constipation after the procedure, which usually resolves within a couple of days. To help normalize your bowel movements, drink plenty of fluids and increase your intake of insoluble fiber. If needed, speak with your healthcare provider about an over-the-counter laxative or stool softener if constipation persists.
While bowel obstruction or injury is rare, call your healthcare provider if you experience any abdominal pain, bleeding, fever, bloating, or are unable to pass gas.
Interpreting the Results
A capsule endoscopy report is more or less the same as a traditional endoscopic report. The report will contain a list of normal and abnormal findings, along with preliminary interpretations.
It will also include details about bowel preparation, the quality of bowel preparation, the extent and completeness of the exam, relevant findings, and so-called “pertinent negatives” (the absence of any important features or findings).
While some findings can be readily observed, such as bleeding or strictures, others may be ambiguous.
Another example is the detection of polyps during the procedure. While certain characteristics of a polyp may be suggestive of cancer (including a larger size and increased vascularity), an enteroscopy may be needed to remove and definitively diagnose the growth. On the other hand, growths that are consistent with cancer (including bleeding, growth clusters, and an irregular, non-capsulated structure) may requirelaparoscopicoropen surgery.
Similarly, while some disorders like celiac disease may be treated presumptively based on the visual findings, many healthcare providers will insist on obtaining a tissue sample so that the disease can betypedand treated appropriately.
In some cases, the test may need to be repeated to obtain better images, particularly if symptoms persist despite a negative result. A retrospective study conducted in 2010, which evaluated 82 people who had undergone more than one capsule endoscopic procedure, concluded that a repeat test yielded a change in treatment in 39 percent of cases. Moreover, nearly half of the people who had an incomplete first test (10 out of 22) had an abnormal finding in the second.
A Word From Verywell
As valuable a tool as capsule endoscopy is, it is not infallible. A test can easily be compromised if you don’t follow the bowel preparation and dietary instructions. Technical glitches can also occur, affecting as many as 8.5% of all procedures, according to a study from the University of British Columbia in Canada.
If the equipment malfunctions, ask for a copy of the endoscopic report and advise your health insurer so that you won’t be double-billed when the test is repeated.
If the test uncovers no unusual findings but you still have symptoms, don’t hesitate to seek asecond opinion. Sometimes having another set of eyes will bring new insights to the investigation. You can usually ask for the report to be forwarded electronically, ideally with the complete video footage in a digital format.
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8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Riccioni ME, Urgesi R, Cianci R, Bizzotto A, Spada C, Costamagna G.Colon capsule endoscopy: Advantages, limitations and expectations. Which novelties?World J Gastrointest Endosc. 2012;4(4):99-107. doi:10.4253/wjge.v4.i4.99Van de Bruaene C, De Looze D, Hindryckx P.Small bowel capsule endoscopy: Where are we after almost 15 years of use?World J Gastrointest Endosc.2015;7(1):13-36. doi:10.4253/wjge.v7.i1.13American Society for Gastrointestinal Endoscopy.Media Backgrounder: Capsule endoscopy.Bandorski D, Kurniawan N, Baltes P, et al.Contraindications for video capsule endoscopy.World J Gastroenterol. 2016;22(45):9898-9908. doi:10.3748/wjg.v22.i45.9898Ninomiya K, Yao K, Matsui T, et al.Effectiveness of magnesium citrate as preparation for capsule endoscopy: A randomized, prospective, open-label, inter-group trial.Digestion. 2012;86(1):27-33. doi:10.1159/000337937Ormeci AC, Akyuz F, Baran B, et al.Retention during capsule endoscopy: Is it a real problem in routine practice?J Int Med Res. 2016;44(4):968-975. doi:10.1177/0300060516645420Svarta S, Segal B, Lw J, et al.Diagnostic yield of repeat capsule endoscopy and the effect on subsequent patient management.Can J Gastroenterol. 2010;24(7):441-44. doi:10.1155/2010/382301Lee M, Jacques A, Lam E, et al.Factors associated with incomplete small bowel capsule endoscopy studies.World J Gastroenterol.2010;16(42):5329-33. doi:10.3748/wjg.v16.i42.5329
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Riccioni ME, Urgesi R, Cianci R, Bizzotto A, Spada C, Costamagna G.Colon capsule endoscopy: Advantages, limitations and expectations. Which novelties?World J Gastrointest Endosc. 2012;4(4):99-107. doi:10.4253/wjge.v4.i4.99Van de Bruaene C, De Looze D, Hindryckx P.Small bowel capsule endoscopy: Where are we after almost 15 years of use?World J Gastrointest Endosc.2015;7(1):13-36. doi:10.4253/wjge.v7.i1.13American Society for Gastrointestinal Endoscopy.Media Backgrounder: Capsule endoscopy.Bandorski D, Kurniawan N, Baltes P, et al.Contraindications for video capsule endoscopy.World J Gastroenterol. 2016;22(45):9898-9908. doi:10.3748/wjg.v22.i45.9898Ninomiya K, Yao K, Matsui T, et al.Effectiveness of magnesium citrate as preparation for capsule endoscopy: A randomized, prospective, open-label, inter-group trial.Digestion. 2012;86(1):27-33. doi:10.1159/000337937Ormeci AC, Akyuz F, Baran B, et al.Retention during capsule endoscopy: Is it a real problem in routine practice?J Int Med Res. 2016;44(4):968-975. doi:10.1177/0300060516645420Svarta S, Segal B, Lw J, et al.Diagnostic yield of repeat capsule endoscopy and the effect on subsequent patient management.Can J Gastroenterol. 2010;24(7):441-44. doi:10.1155/2010/382301Lee M, Jacques A, Lam E, et al.Factors associated with incomplete small bowel capsule endoscopy studies.World J Gastroenterol.2010;16(42):5329-33. doi:10.3748/wjg.v16.i42.5329
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Riccioni ME, Urgesi R, Cianci R, Bizzotto A, Spada C, Costamagna G.Colon capsule endoscopy: Advantages, limitations and expectations. Which novelties?World J Gastrointest Endosc. 2012;4(4):99-107. doi:10.4253/wjge.v4.i4.99Van de Bruaene C, De Looze D, Hindryckx P.Small bowel capsule endoscopy: Where are we after almost 15 years of use?World J Gastrointest Endosc.2015;7(1):13-36. doi:10.4253/wjge.v7.i1.13American Society for Gastrointestinal Endoscopy.Media Backgrounder: Capsule endoscopy.Bandorski D, Kurniawan N, Baltes P, et al.Contraindications for video capsule endoscopy.World J Gastroenterol. 2016;22(45):9898-9908. doi:10.3748/wjg.v22.i45.9898Ninomiya K, Yao K, Matsui T, et al.Effectiveness of magnesium citrate as preparation for capsule endoscopy: A randomized, prospective, open-label, inter-group trial.Digestion. 2012;86(1):27-33. doi:10.1159/000337937Ormeci AC, Akyuz F, Baran B, et al.Retention during capsule endoscopy: Is it a real problem in routine practice?J Int Med Res. 2016;44(4):968-975. doi:10.1177/0300060516645420Svarta S, Segal B, Lw J, et al.Diagnostic yield of repeat capsule endoscopy and the effect on subsequent patient management.Can J Gastroenterol. 2010;24(7):441-44. doi:10.1155/2010/382301Lee M, Jacques A, Lam E, et al.Factors associated with incomplete small bowel capsule endoscopy studies.World J Gastroenterol.2010;16(42):5329-33. doi:10.3748/wjg.v16.i42.5329
Riccioni ME, Urgesi R, Cianci R, Bizzotto A, Spada C, Costamagna G.Colon capsule endoscopy: Advantages, limitations and expectations. Which novelties?World J Gastrointest Endosc. 2012;4(4):99-107. doi:10.4253/wjge.v4.i4.99
Van de Bruaene C, De Looze D, Hindryckx P.Small bowel capsule endoscopy: Where are we after almost 15 years of use?World J Gastrointest Endosc.2015;7(1):13-36. doi:10.4253/wjge.v7.i1.13
American Society for Gastrointestinal Endoscopy.Media Backgrounder: Capsule endoscopy.
Bandorski D, Kurniawan N, Baltes P, et al.Contraindications for video capsule endoscopy.World J Gastroenterol. 2016;22(45):9898-9908. doi:10.3748/wjg.v22.i45.9898
Ninomiya K, Yao K, Matsui T, et al.Effectiveness of magnesium citrate as preparation for capsule endoscopy: A randomized, prospective, open-label, inter-group trial.Digestion. 2012;86(1):27-33. doi:10.1159/000337937
Ormeci AC, Akyuz F, Baran B, et al.Retention during capsule endoscopy: Is it a real problem in routine practice?J Int Med Res. 2016;44(4):968-975. doi:10.1177/0300060516645420
Svarta S, Segal B, Lw J, et al.Diagnostic yield of repeat capsule endoscopy and the effect on subsequent patient management.Can J Gastroenterol. 2010;24(7):441-44. doi:10.1155/2010/382301
Lee M, Jacques A, Lam E, et al.Factors associated with incomplete small bowel capsule endoscopy studies.World J Gastroenterol.2010;16(42):5329-33. doi:10.3748/wjg.v16.i42.5329
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