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Capsule

Endoscopy

Capsule Endoscopy is a major development in endoscopy, now offered by the London

Bridge Hospital Endoscopy Department. It offers images of the entire small bowel and,

unlike standard endoscopy, needs no intubation, no sedation and has no recovery

time.The patient swallows a vitamin-pill-sized capsule which houses a miniature

camera and a radio-transmitter that transmits images to a recording device, and

then is free to go about his or her normal activities during the 7-10 hour recording.

The major indication for Capsule Endoscopy is suspected small bowel abnormality,

usually anaemia, gastrointestinal bleeding or malabsorption. Before Capsule Endoscopy,

the small bowel was a difficult area to examine or to treat. Insertion of a long

endoscope down a patient’s throat (‘push enteroscopy’) is uncomfortable, requires

sedation, and can only reach the first metre or so of the 4m-long tightly coiled small

bowel. Radiological techniques, such as isotope scans and barium follow-through

examinations, are not accurate in detecting the types of vascular abnormality or

tumour that can occur in the small bowel.

Anaemia is the most common reason for Capsule Endoscopy referral. Such patients

usually have had standard endoscopy and colonoscopy without a source of blood

loss found in the upper GI tract or colon, and often have required repeated blood

transfusions because of anaemia. Capsule Endoscopy can make a diagnosis in 30-90%

of such patients (the latter figure in patients actively bleeding), such as arteriovascular

malformations, polyps such as the slowly-growing Gastrointestinal Stromal Tumours

(GIST), small bowel ulcers, and Crohn’s disease. Small bowel Crohn’s disease, celiac

disease and lymphoma may be found in patients referred with malabsorption.

The vast majority of patients have no difficulty in swallowing the 11 x 26mm capsule

with water. They fast overnight and take a bowel cleansing solution the night before.

Sensors are fixed on the front of the abdomen (like ECG electrodes) to record

the images and the course of the capsule.The PillCam takes about 7-10 hours to

move through the small intestine, taking two pictures per second. During this time,

the patient can leave the hospital and can go about a regular routine while wearing

the recorder. Later, the person returns to hand over the sensors and data recorder,

and the images are viewed.The disposable capsule, its battery life exhausted, spends

another 24-72 hours in the large bowel before being passed (usually unnoticed) by

the patient.The procedure is very safe; if there is a small bowel stricture there is a

small risk of capsule retention requiring surgical removal and definitive treatment

of the stricture at the same time.

Image of the small bowel obtained by Capsule Endoscopy

Drs Simon Anderson and John O’Donohue, Consultant

Gastroenterologists, provide the service in the Endoscopy Department –

Tel: +44 (0) 20 7234 2631

Referrals to Dr Anderson’s secretary –

Tel: +44 (0) 20 7234 2293 Fax: +44 (0) 20 7234 2998

Referrals to Dr O’Donohue’s secretary –

Tel/Fax: +44 (0) 20 8333 1777

A Way Forward

9

rvice

Once the diagnosis is established,

treatment is normally by venesection.

London Bridge Hospital offers a full

venesection service.

Advice to air travellers and the

question ofThrombophilia

There has been much varied advice given

to air travellers on long haul flights.

Dr Saáry offers comprehensive

advice on the prevention of Venous

Thromboembolism, as well as guidance

onThrombophilia screening.

Contacts:

GP Liaison:

+44 (0) 20 7234 2009

Dr Saáry:

+44 (0) 7860 138 304

In Dr Saáry’s absence, contact

Dr Lesley Kay:

+44 (0) 20 7908 2103

Key Points

• Diagnose HIV early

• Many drugs available

• Careful monitoring of drug effects

is crucial

• Promptly manage the sick

HIV patient

To arrange an appointment

please contact GP Liaison:

Tel: +44 (0) 20 7234 2009

NRTIs

• Zidovudine

(AZT)

• Didanosine

(ddi)

• Zalcitabine

(ddC)

• Stavudine

(d4T)

• Lamivudine

*

(3TC)

• Abacavir

• Trizivir

®

*

Also active for Hep B

NNRTIs

• Nevirapine

• Efavirenz

• Etravirine

Fusion

Inhibitors

• T20

Entry

Inhibitors

• Maraviroc

Nucleotide

Inhibitors

• Tenofovir

*

Integrase

Inhibitors

• Raltegravir

PIs

• Indinavir

• Ritonavir

• Saquinavir

• Nelfinavir

• Amprenavir

• Fosamprenavir

• Lopinavir with

ritonavir

• Atazanavir

• Darunavir