Gastroenterology - Capsule Endoscopy/'Pill Cam'

This leaflet has 3 aims:

1. To help you become better informed and more involved in your care.
2. To explain what happens on the day of the procedure.
3. To answer some of the questions commonly asked about the procedure.

If you have any questions, access or communication needs such as an interpreter please contact the department stated on your appointment letter.

Reasonable adjustments will be considered for all disabled users of this service.

Please make sure that you read the following information CAREFULLY.

Your doctor has referred you for a capsule endoscopy or more commonly known as the ‘pill cam’ test.

What is capsule endoscopy?

A capsule endoscopy or pill cam is a small ‘pill’ sized camera that is swallowed so that pictures of your gut can be taken. This allows your consultant to have a look mainly at your small bowel, which cannot be reached or looked at by a normal endoscopy.
Most people will have had an endoscopy first.

Why am I having this test?

Your consultant has asked you to have this test because they may suspect that you are bleeding in your small bowel, or maybe looking to see if you have any inflammation in your gut that wasn’t found on your endoscopy. You may have symptoms of diarrhoea, abdominal pain or anaemia.

It is important that you inform us as soon as possible if you are due to have an MRI scan, as this will affect when you have this test done.

What do I need to do before the test?

From lunch time the day before the test please have liquids only but please avoid lumpy or cream-based soups. From 4pm you will start to take the bowel prep (see below). Once the bowel prep has been taken, please have water ONLY until midnight. From midnight please do not have anything to drink or eat.

You will be given some bowel preparation to take from 4pm over a 1-3 hour period. Specific instructions will be given to you regarding how to take this. Please follow the instructions regarding bowel prep carefully as it is important that there is no food left in your gut prior to the test.

You will need to stop certain medications.

MEDICATION TO BE STOPPED FOR CAPSULE ENDOSCOPY

Please stop all gut motility altering drugs 3 days before the test date.

These include:
Iron
Domperidone (motilium); metoclopramide (maxolon); ondansetron; alverine; baclofen (lioresal), mebeverine (colofac); peppermint oil (colpermin, mintec,), merbentyl (diclomine, bentyl, hyoscine (buscopan), pro-banthine, spasmanol, colesevelam, prucalopride.

If you are taking any of the medications below, please contact the department prior to your appointment as these medications slow your gut and can result in the capsule taking longer to leave your body. In some cases, we will ask you to stop these medications prior to the test, but we will discuss this with you when you contact us:

Antidiarrheal medication such as Imodium or loperamide.

Morphine or any other opiate containing medication

Fentanyl patches

Tramadol

If you are taking a medication which is not on the list, but you think may have an effect on your gut especially slowing your gut down, please contact the department, the contact details are on your appointment letter.

On the day of the test please do not apply any body lotion or powder to your abdomen and wear loose-fitting, two-piece clothing.

What happens during the test?

When you arrive the physiologist will ask you some basic questions and explain what will happen. You will have some pads placed on your abdomen or a belt around your waist which will be connected to a recorder. You will then carry the recorder with you over your shoulder. You will be asked to swallow the ‘pill cam’ with water that contains Infacol (to reduce air bubbles so that the camera has a clear view). You will be given some instructions (see below) once you have swallowed the capsule. Once the capsule is in your stomach you are then free to go home. You will need to return to the department BEFORE 9am the following day.

You will not be able to have anything to eat or drink for the first 2 hours, after swallowing the capsule, for the second 2 hours you can have clear fluids only. After 4 hours you may resume your normal diet, although please avoid soup, tea and coffee at this meal as this can move through your gut quickly and could obscure the view of the camera.

We need a minimum of 12 hours recording. When you are ready to go to bed, please remove the belt or the pads from your abdomen, using the tab, and place these along with the recorder in a bag ready for returning to the department. Please DO NOT wrap the leads or cables around the recorder or fold them over. Once you have removed the recorder you can resume any medication that you have stopped for the test.

What happens after the test?

You will return the recorder and the pads/belt to the department you visited on day 1 where the data will be uploaded.

With regards to the capsule, you will pass this naturally. This may not be on the day of the test, however whenever you go to the toilet please check if you have passed it. It is advisable to look to see if you have passed the capsule when you have a bowel action, however you may not know that you have passed the capsule. If in the future you have an MRI scan and you are not 100% certain you have seen the capsule, please notify the hospital where you are having the scan as they will need to perform a plain abdominal x-ray to see if the capsule has been retained. Should you start to have any abdominal pain either contact the department on your appointment or your GP. If this is out of hours contact 111.

Are there any complications or side effects?

Complications are very rare, however there is a risk of surgical intervention if the capsule becomes stuck (capsule retention). Please be aware of the following:

• Trouble swallowing or
• Increasing chest or abdominal pain
• Unusual difficulty in opening your bowels

Tell your doctor immediately or alternatively go to your nearest A&E.

Benefits and Risks

The benefit of having this test is that it will help your doctor determine what is happening with your bowel.

There is a <0.75% risk of surgical intervention due to the capsule getting stuck. However, your referring consultant will have already determined that the capsule would pass through your gut safely. You will pass the capsule naturally when you have a bowel action.

If you have any questions, please contact the department on your appointment letter.

There is no alternative to this investigation other than not going ahead with this investigation.

Smoking Policy

Northern Care Alliance operates a smoke free policy. To find out what this means for you, pick up the leaflets available at the hospital. For advice on stopping smoking contact 0161 212 4050.