The small intestine is very long (around 20 feet) and is difficult to access for diagnosis of diseases or evaluation of symptoms. A single or double balloon enteroscopy is a relatively long and arduous procedure to access and visualize the small intestine (also called the small bowel). Given these challenges, Gastroenterologists use a tiny wireless capsule (the video capsule) to visualize the small intestine. The capsule, once swallowed, sends images to a recorder that you wear on a belt.
How is VCE done?
We use a modified bowel preparation to cleanse the small bowel on the day before your scheduled procedure to ensure the quality of the pictures is not obscured by food residue.
The capsule is approximately 23mm (just under 1 inch) and is swallowed on an empty stomach. We will ask you to come to the lab on the scheduled day around 6:45am. After signing the appropriate consent and other paperwork, the technician will attach the recorder on your waist, and you will swallow the capsule under supervision. Once we go through instructions with you, you are free to leave and return around 2:45 to return the recorder for us to download the images to review and report.
What is the bowel preparation for VCE?
7 days prior to your scheduled procedure, please stop all iron supplements and/or multivitamin supplements.
2 days prior to your scheduled procedure, we will ask you to buy the 7-dose bottle of Miralax (119gms), available over the counter.
On the day prior to your procedure, have a normal lunch but no solid food after this (no snacks or dinner please). Please drink plenty of water and clear liquids after this.
At 6pm, mix the 7 dose Miralax (119gms) with 32 ounces of any light-colored Gatorade (no red or dark colors please. Safest option is lemonade) and drink the entire bottle by 8pm. Continue to drink water until you go to bed and then do not drink or eat anything.
Reach the GI lab (we will give you instructions on location) no later than 6:45am.
How safe is VCE?
Capsule endoscopy is safe, and complications are rare. Usually the capsule passes freely through the small intestine and colon. Rarely, it may get lodged in abnormally narrow areas or pockets (for example, if you have had prior bowel surgeries or narrowed areas due to inflammatory conditions like Crohn’s disease, tumor, scar tissue or after radiation therapy). In some people with abnormally slow motion of the bowel, the capsule may take longer to pass or remain lodged.
If you have any clinical risk of narrowing of your intestine, your doctor is likely to order a dummy dissolvable capsule study (called a patency capsule) and a plan X ray of the abdomen 48 hours after you swallow the dummy capsule. Alternately, he may order another imaging study like a CT or MR small bowel study prior to doing a capsule endoscopy to reduce the likelihood of the capsule getting stuck.
If the capsule is taking longer to pass but is not causing signs and symptoms, your doctor may give the capsule more time to leave your body. If the capsule causes signs and symptoms that indicate bowel obstruction, it must be removed, either by surgery or through a traditional endoscopy procedure, depending on the location.
How about food and medications after I swallow the capsule?
Two hours after you swallow the capsule, you may start to drink clear liquids. After four hours, you can have a light lunch or a snack unless your doctor tells you otherwise.
The capsule endoscopy procedure is usually complete after about eight hours or when you pass the capsule during a bowel movement, whichever comes first.
Return to the GI lab for the nurse/technician to remove the patches and the recorder belt from your body.
Passage or expulsion of the capsule through a bowel movement occurs within the two weeks, usually within the first two days depending on your individual bowel habits, bowel speed etc, etc. If you do not see the capsule in the toilet within two weeks, contact your doctor. Your doctor might order an X-ray to see if the capsule is still in your body.
When and how do I get the results of the VCE?
Usually the doctor looks at the video of the endoscopy within 1 week and will mail out the results. If there are any significant abnormalities, the doctor will call you to discuss the results as well as any recommendations.