Capsule endoscopy

This examination involves swallowing a single-use capsule, about the size of a large pill, which takes images of the small intestine lining without the need for general anesthesia. It is a reference endoscopic test for diagnosing small bowel diseases.

It is usually prescribed when gastroscopy (upper endoscopy) and colonoscopy have not identified the cause of your symptoms. A small bowel disorder may then be suspected, particularly in cases of bleeding, anemia, or intestinal inflammation.

The video capsule can also complement imaging studies such as MRI or CT scans of the small intestine.

If this examination is not performed when necessary, it may negatively affect your health by delaying or missing a potentially serious diagnosis (vascular, inflammatory, or tumor lesions of the small intestine).

If an abnormality is detected, further imaging (MRI or CT scan) or endoscopy under general anesthesia for biopsy or treatment may be recommended.

The small intestine must be properly prepared to allow clear visualization of its walls during the examination.

Preparation will be prescribed by your doctor. You will be asked to:

• Stop any oral iron supplements 7 to 10 days before the exam
• Possibly follow a specific diet in the days prior
• Fast completely from the evening before the exam until the capsule is swallowed

A bowel cleansing solution and sometimes medication to reduce intestinal bubbles may also be prescribed. In rare cases, medication may be given to help the capsule pass from the stomach into the small intestine.

Despite proper preparation, image quality may sometimes be insufficient, requiring the exam to be repeated or completed by another test.

Medications may be affected by the preparation, including oral contraceptives.

Make sure to inform your doctor of your medical history and all medications you are taking.

At admission, basic checks are performed before you swallow the capsule with a glass of water.

Depending on the device used:

• External sensors may be placed on your abdomen or back
• You may need to wear a recording device on a belt or shoulder strap

These devices transmit images for at least 8 hours. It is essential to keep them in place during the entire recording period.

Some capsule models do not require external devices. In this case, you may be asked to retrieve the capsule from your stool using a provided strainer after the examination.

If the procedure is not done in hospital, you can usually go home shortly after swallowing the capsule.

Physical activity (walking) is recommended to help the capsule move through the digestive tract.

Unless otherwise advised:

• You may drink 2 hours after swallowing the capsule
• You may eat 4 hours after swallowing the capsule

You should avoid close proximity to devices that may interfere with image transmission (certain medical devices, radiology equipment, magnetic systems, etc.).

The capsule is usually eliminated in the stool within 24 to 48 hours. You will be asked to return the recording equipment and/or the capsule, depending on the system used.

MRI is contraindicated until capsule elimination is confirmed.

As with any medical procedure, complications may occur, although they are rare.

Proper bowel preparation is essential for optimal examination quality.

Possible complications include:

• Aspiration of the capsule into the airway (very rare): may require emergency intervention. Any swallowing difficulties should be reported beforehand.
• Capsule retention in the stomach or small intestine: usually without symptoms. Risk factors include long-standing diabetes, inflammatory bowel disease, prior digestive surgery, radiotherapy, or long-term anti-inflammatory use. Additional imaging or a “patency capsule” may be performed beforehand.
• Capsule obstruction (impaction) in a narrowed segment of the intestine: extremely rare but may cause bowel obstruction (abdominal pain, nausea, vomiting, or absence of gas/stool). This requires urgent medical attention and may require surgery.

If symptoms occur after the exam (pain, fever, etc.), contact your gastroenterologist, treating physician, or the facility where the procedure was performed immediately.