Capsule endoscopy
This leaflet has been written by staff working in the Endoscopy Unit at Chelsea and Westminster Hospital.
We hope you find it useful. If, after you have read it, you have any questions or concerns, please ring us on our direct line 020 3315 3056/5223.
When you come into the Unit (2nd Floor, Lift Bank B), please talk to us about any worries and ask any questions you have.
If you would like to change your appointment time or date, please contact the Endoscopy Unit booking team on 0203 315 4141/5984 or email us Chelwest.cwdiagnosticcentre.admin@nhs.net.
Your appointment time in Endoscopy is approximate because some procedures may take longer than expected and emergency procedures need to take priority. Please expect to be in the department for several hours – having pre-procedure checks, the procedure and for recovery after the procedure.
What is a capsule endoscopy?
This involves swallowing a small capsule (the size of a large vitamin tablet) which will pass naturally through your digestive system taking pictures of the intestine. The images are transmitted to sensors attached to a data recorder held in a harness. The capsule is disposable and will be excreted naturally in your bowel movement.
Why do I need to have a capsule endoscopy?
The main reason is for the diagnosis of obscure gastrointestinal bleeding. The overall success rate of capsule endoscopy is about 60%, significantly higher than other tests (push enteroscopy 26%, and barium studies 8%.) It is best to perform capsule endoscopy as soon as possible during/after the bleeding episode.
In addition capsule endoscopy is being used increasingly for the diagnosis of Crohn’s disease or diagnosing small bowel tumours. In these cases, it provides a diagnosis in about half of the studies compared to 20% for standard barium studies. It has been used to detect small bowel injury associated with the use of anti-inflammatories, and determining the cause of abdominal pain.
What are the risks?
There is a small risk (1 in 150) of the capsule getting stuck which may result in surgery—in the majority of these cases, surgery is necessary anyway due to disease. Therefore surgery for the sole purpose of removing a capsule is only required in about 1 in 750 cases. In certain patients (eg those with intestinal fistulas or strictures, Crohn’s disease or with prior abdominal/pelvic surgery), the doctor will organise a radiological test like MRI or CT, or a patency capsule study. Capsule endoscopy is not usually performed in patients who are pregnant.
Drugs
Please continue to take your regular medication. If you are prescribed iron tablets (eg ferrous sulphate) or non-steroidal anti-inflammatory drugs (such as ibuprofen, diclofenac, celecoxib) please stop these one week before your appointment. Do not take calcium channel blockers, Gaviscon®, Maxalon™, Motilium®, or codeine on the day of the test. If in doubt, check with your doctor or contact the Endoscopy Unit.
Day before your procedure
You must stop smoking for 24 hours before your test. You will need to start a clear liquid diet after lunch the day before your test. Black tea and coffee, squash, carbonated drinks, water, clear soup, Bovril® and Oxo® are permitted. Clear jelly and boiled sweets are also permitted. From 10pm on the evening before your test do not eat or drink anything except for water and/or medication.
On the day of the capsule endoscopy
Do not take any medications for 2 hours before your test. Please dress in loose-fitting two-piece clothing. A cotton t-shirt is ideal.
On admission to the unit a Nurse will ask you several questions about your health, current medication (please bring an up to date list with you). This will give you the opportunity to discuss your test and ask questions before signing a consent form.
You will be taken to the cubicle where adhesive sensor pads will be applied to your abdomen. These will be connected to a data recorder which you need to wear in a pouch around your waist.
After swallowing the capsule
Once you have swallowed the capsule you must not go near any source of powerful electromagnetic fields—such as near an MRI or amateur radio—for at least 8 hours.
As you may present an unusual and perhaps worrying appearance to others when wearing the recorder belt which has lights flashing on the data recorder, we advise you not to travel on public transport.
Do not eat or drink for 2 hours. After 2 hours you may drink clear fluids such as water, fruit squash or tea/coffee without milk. After 4 hours you may have a light snack.
If you suffer from any abdominal pain, nausea or vomiting during this time you must contact the Endoscopy Unit immediately on 020 3315 3056/5223.
Your test will last about 8 hours—please do not disconnect or remove the belt at any time during the test. Do not have a bath or shower.
Handle the equipment carefully and avoid sudden movements and banging the (blue) data recorder. Do not expose it to shock, vibration or direct sunlight as this may result in loss of information.
During your test you will need to check every 15 minutes that the small light on top of the data recorder is blinking twice per second. If it stops blinking at this rate, record the time and contact the Endoscopy Unit.
You should record the time and nature of any events on the capsule endoscopy event form (see the purple panel in this leaflet)—such as eating and drinking or any unusual activity. Avoid any strenuous activity, especially if this involves sweating, and do not bend over or stoop during the eight hour period.
After completing the capsule endoscopy
You will be asked to return to the Endoscopy Unit to return the equipment with your capsule endoscopy event form. This is usually at 4:30pm.
You may start a normal diet when the test is completed. The capsule is normally passed in your stool 2–3 days after your test. It can be flushed down the drain safely.
If you are diabetic
As you have diabetes, you are at an increased risk of developing a low level of blood sugar when you do not eat for a prolonged period, called a ‘hypo’, which may produce sweating, shaking, and blurred vision. To avoid this occurring while you are preparing for your test, please follow the instructions below.
Have additional sugary/glucose drinks at home such as Lucozade™ or sugar-containing fizzy drinks. If you think you are having a hypo, take a glucose drink or 3 glucose tablets immediately.
Day before the procedure
Take your insulin/diabetic tablets with your breakfast and lunch as usual. Do not eat anything after 2pm until after your test. For the rest of the day, you should take sugary drinks regularly, for example, 100mls every 2 hours. If possible check your blood sugar level and take less sugary drinks if it rises above 10mmol/l and more if it falls below 4mmol/l.
Once you are taking fluids only, reduce your injected insulin dose by half. If you take diabetic tablets, continue to take them as normal. Stop taking any fluids at midnight.
Day of the procedure
The appointment will be at the beginning of the day. In the morning do not take your insulin/diabetic tablets. If possible, check your blood sugar before you travel to the hospital. If it is very low (less than 3.5 mmol/l) or you think you are having a hypo then drink a clear sugary drink. Bring your insulin/diabetic tablets and take half the dose when you have your light lunch and normal dose from the evening.