Small-bowel capsule endoscopy
Information for patients from the Endoscopy Unit
You have been referred to the Endoscopy Unit for a small-bowel capsule endoscopy. This leaflet will explain:
why you ned a capsule endoscopy
what a capsule endoscopy is
what will happen during your procedure.
If you have any questions, please contact the Endoscopy Unit on 01227 783191.
Why do I need a capsule endoscopy?
There are many reasons why you may need a capsule endoscopy.
You may have iron deficiency anaemia.
You may have bleeding from an area not reachable by a standard endoscopy.
We may need to check the clinical importance of abnormalities found on a previous barium study or scan.
We may need to check a pre-existing condition, such as inflammatory bowel disease (IBD).
A capsule endoscopy will allow us to get a better look at your small bowel. This will help us find out what is causing your current symptoms and discuss your treatment options.
What is a capsule endoscopy?
This test is an accurate way of looking at the lining of your small bowel.
The procedure involves swallowing a small capsule. This capsule is slightly bigger than a large vitamin tablet.
The capsule will pass naturally through your digestive tract (see diagram below).
The capsule travels through your small bowel, taking approximately 50,000 images.
During the test you will wear a comfortable sensor belt around your abdomen (stomach). The belt can be adjusted and secured with Velcro straps.
The sensor belt is attached to a small data recorder box, which is kept in a shoulder bag.
The capsule then transmits the images to a data recorder for approximately 8 to 10 hours.
Will I have to stay in hospital?
No. The procedure normally takes 8 hours to complete, but you do not need to stay in the Endoscopy Unit all day. On the day you will be given a time to return to the Unit. When you return the equipment will be removed.
Are there any alternatives?
Capsule endoscopy is usually used when other methods have failed to provide specific information about your small bowel. This can include procedures such as gastroscopy, colonoscopy, and CT / MRI scans.
Alternatives, like double balloon enteroscopy, involve passing a long endoscope into your small bowel. This procedure may not be tolerated by all patients. The type of test you have will be decided after speaking with your consultant.
Is there anything I can do before I come into hospital to improve the capsule examination?
For this test to be successful, your stomach and small bowel must be totally empty.
The day before your capsule endoscopy
Eat your normal diet until 1pm.
After 1pm only drink clear fluids until 10pm. Examples of clear fluids are:
water
apple or grape juice
tea or coffee without milk
herbal tea
clear fizzy drinks, such as Sprite or Lucozade
clear jelly, and
ice lollies (not red).
After 10pm do not eat or drink anything until after your procedure the following morning. You may be given further dietary instructions.
Only take essential medication with a small amount of water. Please contact the Endoscopy Unit if you are unsure.
If you are a smoker, do not smoke 24 hours before your arrival time.
Do not chew gum.
What will happen when I arrive at hospital?
The day of your capsule endoscopy
Do not eat or drink anything, except necessary medications. If you take medications, either:
take them at least 2 hours before your arrival time, with a small amount of water; or
do not take them until 4 hours after you swallow the capsule.
When you arrive at the Endoscopy Unit, you will be greeted by a nurse. They will ask you a few questions and discuss the procedure with you. You will be asked to sign a consent form. If you have any questions, please ask.
Your nurse will attach the belt to your abdomen, and fit you with a shoulder bag to carry the data recorder.
You will then swallow the capsule, with water mixed with medication called Infacol. The medication prevents air bubbles.
On the day of your procedure, dress in loose-fitting clothing. Ideally two-piece clothing, as this makes it easier when attaching the sensor belt.
Why do I need to sign a consent form?
All patients must give permission before they receive any type of medical treatment, test, or examination. Consent is usually given when you sign the consent form before your treatment, but we may ask you to give it verbally.
You must give your consent voluntarily.
The hospital must give you all the information you need to make a decision about your treatment. This is so you can give us informed consent. If you have not been given this information, or you have but you still have questions, please speak to a member of staff.
You must be capable of giving consent. This means that you understand the information given to you and can make an informed decision.
When we ask you to give consent, please use this time to ask any questions you may still have. For more information, please go to the NHS Consent for Treatment web page. Remember, you can withdraw your consent for treatment at any time.
After swallowing the capsule
Only drink water.
Do not eat anything until 2pm. After 2pm, you can have a light lunch, such as a sandwich, soup, or egg on toast.
If you did not take your usual medication at 6am before you swallowed the capsule, you can take this now, unless you are told otherwise.
If you are a smoker, you cannot smoke until the data recorder is removed following your procedure.
Please be very careful with the data recorder.
Do not get it wet.
Do not bang it and avoid sudden movements.
Do not disconnect the data recorder from the belt or take off the data recorder belt.
Avoid strenuous activity. Do not bend or stoop, as this may interfere with the transmission of images from the capsule to the data recorder.
If the data recorder disconnects from the sensor belt, do not reconnect it. Please contact the Endoscopy Unit immediately on 01227 783191 and speak to the nurse-in-charge.
Check every 30 minutes that the light on top of the data recorder is blinking twice per second. If it is not blinking at this rate, record the time on your “Events Form” and contact the Endoscopy Unit on 01227 783191 and speak to the nurse-in-charge.
You will be given a “Capsule Endoscopy Events Form” by your nurse. Please use this form to record the time that you eat, drink, or feel anything unusual during your procedure. If you notice any changes in the data recorder, please note this as well. This can include the blinking light stopping flashing, or changes in the colour or sounds heard.
Call the Endoscopy Unit on 01227 783191 and speak to the nurse-in-charge if you:
have any abdominal pain
feel sick, or
vomit (are sick).
You will be asked to sign an “Equipment Record Form” when you leave the department wearing the equipment. This reminds you to take responsibility for the medical equipment during the day. When you have returned the equipment you will need to sign the form again.
Do not go near electromagnetic fields until you have passed the capsule in your stools (poo). This includes MRI scanners or radio transmitters, and is due to metal parts in the capsule. If you have an MRI scan appointment this may need to be postponed.
Please return to the Kent and Canterbury Hospital Endoscopy Unit promptly at 5pm, for the data recorder to be removed.
Once the test is completed, you can eat and drink as normal.
The capsule is normally passed in your stools (poo) 24 to 72 hours after swallowing. It can be flushed safely down the toilet.
What about my medication?
Please bring to your appointment a list of the medication(s) that you currently take.
If you take oral iron tablets, stop taking these 1 week before your appointment.
Do not take codeine or codeine-containing painkillers, such as Co-Codamol and Dihydrocodeine, for 1 week before your procedure. Use paracetamol-based painkillers instead. Your GP will be able to suggest alternatives if you have difficulty.
If you have diabetes, please contact the Endoscopy Unit on 01227 783191 and speak to the nurse-in-charge.
Are there any risks or complications with having a capsule endoscopy?
The capsule passes through your digestive tract and is eliminated naturally, although this may take up to 2 weeks for some people.
Small-bowel capsule endoscopy is a safe procedure and well-tolerated by patients. The main risk to the test is capsule retention, in other words the capsule gets stuck. It is estimated that this occurs in approximately 1 in every 100 cases.
Capsule retention is usually caused by narrowing of the bowel lumen. If this happens, the capsule can be removed either with laxatives or through endoscopy, however an operation may be needed.
Will I need any additional procedures?
Some patients are unable to swallow the capsule, and may need to have it placed using an endoscope. This procedure is called endoscopic placement. This is not carried out in Kent and Canterbury Hospital. If this happens the referring consultant will be told, as the patient may need to be referred to another hospital for the endoscopic placement.
How will I feel after my procedure?
This procedure is non-invasive. You can drive as soon as you leave the hospital. If you feel at all unwell at home, please contact the Endoscopy Unit.
Avoid any powerful electromagnetic fields, particularly an MRI scan, until the capsule has passed.
When / how will I get my results?
As soon as the images are read, we aim to send the report to your referring consultant within 2 weeks. They will discuss your results with you. A copy of this report will also be sent to your GP.
Contact details
If you have any questions, please contact the Endoscopy Unit on 01227 783191 and speak to the nurse-in-charge.