1. Kendall Yoshisato, RN, CGRN
Capsule Endoscopy
Kendall Yoshisato, RN, CGRN
Northern CA SGNA
September 22, 2012

2. OBJECTIVES Understand the history of small bowel exploration
Review the indications for capsule studies
Discuss the nursing assessment/education for capsule endoscope
Describe the role of the nurse reviewer

3. Capsule Endoscopy History of Small Bowel Imaging Radiology
Small Bowel Follow Thru
Angiograms
Tagged Red Blood Cell Studies

4. Capsule Endoscopy Given; Olympus; IntroMedics (Korea); OMOM (China)
History of Small Bowel Exploration
Use of colonoscopes
Sonde Enteroscopes
Development of push enteroscopes
Capsule Endoscopy (2001)
Given; Olympus; IntroMedics (Korea); OMOM (China)
Double Balloon/Single Balloon Enteroscopy (Japan 2001)

5. Capsule Endoscopy Current Capsule use: Small Bowel Esophageal
Obscure GI bleeding
Small Bowel Disorders
Tumors
NSAID ulcers
Celiac/Sprue
Crohn’s Colitis
Esophageal
Varicies
Barrett’s Esophagus

6. Capsule Endoscopy – Small Bowel
Process:
Prepares bowel using standard colon prep
Sensor Array applied
Ingest Capsule

7. Capsule Endoscopy – Small Bowel
Wait 6-8 hours
Download images

8. EGD Capsule Placement

9. Capsule Endoscopy - Esophagus
Patients typically fast for two hours prior to undergoing the PillCam ESO procedure. Upon arriving the physician’s office, patients follow the Simplified Ingestion Procedure (SIP). While standing, a patient will first drink 100 mL of water. They will then be asked to lie on their right side, swallow the PillCam ESO video capsule and take one sip of water every thirty second for seven minutes. After seven minutes, the nurse will instruct the patient to sit upright, drink another sip of water and wait for thirty seconds. The PillCam passes naturally with a bowel movement usually within twenty-four hours.

10. Nursing Assessment/Education
Procedure Preparations
Standard Colon Preparation
½ Colon Preparation
Clear Liquids

11. Nursing Assessment/Education
Patient is able to meet time parameters (8 hour study).
Patient has a valid consent.
Patient is responsible to return equipment.
Patient is able to understand and perform colon preparation.
Patient is able to tolerate clear liquid diet.
Patient does not have any swallowing disorders. (Review radiological studies).
Patient does not have or suspected to have a gastrointestinal obstruction. (Review radiological studies).
Patient does not have or suspected to have strictures.
Patient does not have or suspected to have fistulas.
Patient does not have or suspected to have a Zenker's or Meckel's Diverticulum.
Patient does not have a cardiac pacemaker or implanted electromedical devices.
Patient does not have a history of or suspect slow gut transit time.
Patient does not have an MRI scheduled within 1 week of capsule ingestion.
Patient is not pregnant. LMP for women of child bearing ages.
Patient requires EGD for capsule placement.
Type of work. Check for possible electromagnetic issues.

12. Agile Capsule

13. Nursing Assessment/Education
Once the capsule is ingested
Document the time the capsule was swallowed
You may start clear liquids 2 hours after swallowing the capsule. You may take your
necessary medications at this time. **Nothing Red.
You may have a light lunch (half sandwich/cup of soup, etc) 4 hours after swallowing
the capsule.
You should not be near any source of electromagnetic fields (MRI, Ham radio) or
microwave oven.
5. NO strenuous physical activity, including bending over during the exam.
You will need to check the blue light on the top of the data recorder every 15
minutes during the exam. The exam takes approximately 8 hours.
7. DO NOT DISCONNECT the equipment during the exam.
DO NOT enter federal or state buildings, airports, or banks with metal detectors
while wearing the recorder.
9. Return to GI Clinic if you have nausea, vomiting or abdominal pain.

14. Streamlined Functionality – Function Bar
PillCam SB
Function bar
Progress Indication available for full videos and only in A-mode
(not in M-mode nor for video segments)

15. Streamlined Functionality – Tooltips
Place mouse cursor over any icon on the RAPID main screen for Tooltip to display

16. Capsule Endoscopy

17. Capsule Endoscopy
Small Bowel Capsule Images:

18. Capsule Endoscopy
Esophageal Images:

19. FICE Literature Review
Computed Imaging Modification for Enhancement of Small-Bowel Surface Structures at Video Capsule Endoscopy
By emphasizing lesion hypervascularity and vascular morphology, FICE might aid in differentiation of neoplastic and non-neoplastic lesions
This novel imaging technique has the potential to improve the diagnostic yield of video capsule endoscopy for obscure gastrointestinal bleeding
Endoscopy 2010;42(6):

20. Report Templates Template Localization Progress Indicator 1 ON 2 OFF 3
Referring physician’s reason for referral
Template
Localization
Progress Indicator 1 ON 2
OFF 3 4
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Referring physician’s reason for referral
Electronically Signed by:
Moti Frisch MD /06/2010

21. RAPID Real-Time v7.0 FEATURES Key Feature Comment
Standard USB cable
DR 2
DELL 2100
FEATURES
Key Feature
Comment
Dedicated real-time only software
No RAPID Reader
Lower pricing
Dell 2100 platform lowers costs while maintaining product quality
Functionality
Touch screen
Small size enables hand held use
Support for all PillCam video capsules

22. Capsule Endoscopy Limitations: Diagnostic only
Can’t control image view/direction
Cannot inflate the bowel
Limited field of view
Still requires bowel prep
Takes 6-8 hours
May require EGD to pass capsule
Capsule can be retained/cause bowel obstruction

23. Smart Pill Wireless Motility Capsule
Measures pH, pressure and temperature
Ingests the capsule after a meal.
Wears data receiver for up to 5 days
Excreted in stool after hours

24. Smart Pill

25. Future of Capsule Endoscopy
Colon Capsule
Steering
Drug Delivery
Biopsy

26. Magnetically Guided Capsule Endoscopy

27. Swimming Capsules

28. Robotic Capsules

29. Drug Delivery Capsules