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Digestive Diseases Qld provide capsule endoscopy services through Dr Mark Appleyard. Dr Appleyard is a visiting specialist at DDQ and consults once a fortnight out of our Holy Spirit Northside rooms. (Please note that Dr Appleyard ONLY offers capsule endoscopy services through this practice)
Capsule endoscopy involves swallowing a video capsule the size of a large antibiotic capsule to examine the small bowel. The procedure is commonly undertaken if your doctor suspects that you have bleeding, inflammation, ulceration or other abnormalities of the small bowel. An alternative test to capsule endoscopy is a barium x-ray study of the small bowel or push enteroscopy. In some situations barium tests are more useful than endoscopy, but for examination of the small bowel endoscopy is usually more sensitive and specific than a barium test. The push endoscopy does allow biopsies to be taken, but will only examine the first quarter of the small bowel. The capsule will examine the entire small bowel.
Capsule endoscopy Procedure
WHAT PREPARATION IS REQUIRED?
It is essential that your stomach is empty during the procedure to ensure the doctor has a clear view. You should have CLEAR FLUIDS FROM MIDDAY THE DAY BEFORE and then be NIL BY MOUTH FROM MIDNIGHT (no food, fluids, water or smoking) for a morning procedure. You should take your normal medication with a sip of water. You should leave all valuables at home as the hospital cannot accept responsibility for items lost or stolen. For males shave the abdomen 6 inches above and below the navel. Women please be sure to wear a two piece outfit.
Diabetics should reduce their insulin doses the evening before and on the morning of the test. Morning diabetic tablets should be taken with lunch.
WHAT HAPPENS WHEN I ARRIVE ON THE UNIT?
When you arrive at the Endoscopy Unit a nurse or one of the reception staff will meet you. You will be asked to take a seat in the waiting room. A nurse will take your medical details to ensure you are correctly and safely prepared. This time gives you an opportunity to ask any further questions you may have regarding the procedure. You will have some aerials attached to the abdomen with sticky pads and be asked to wear a belt. You will then be asked to swallow the capsule with a cup of water containing wind drops (This reduces the bubbles in the bowel and is usually given to babies for wind pains).
WILL I BE ASLEEP FOR THE PROCEDURE?
No sedation is required as the procedure is painless.
WHAT HAPPENS AFTER THE PROCEDURE?
Once you have swallowed the capsule you will remain nil by mouth for 4 hours. You will then be allowed to drink clear fluids such as water or cordial. 5 hours after swallowing the capsule you will be allowed to have lunch. You will be allowed home immediately after swallowing the capsule. You must return after 8 hours to have the belt removed and the images processed.
HOW DO I GET THE RESULTS?
The report will be sent to you, the referring doctor (and/or your GP) and a copy retained in my records. In most cases you can discuss your results with your referring doctor and/or GP. The results are usually available within 1-2 weeks, but may be a little longer.
WHAT ARE THE RISKS INVOLVED FROM A capsule endoscopy?
Before you agree to this procedure you should be aware of the reason for which it is being proposed, the alternatives and the problems that can occur. No treatment or procedure is totally risk free, but capsule endoscopy is extremely safe. The main complications following capsule endoscopy are mentioned below.
· There is a very small risk of the capsule getting stuck in the bowel if a narrowing is present (approximately 1 in 100). The narrowing cannot always be predicted before the procedure. If the capsule does get stuck it is unlikely you will get symptoms. The narrowing will usually be seen when reviewing the video, you will need to have an x-ray and you may require an operation to remove it.
· The capsule does not reach the large bowel after 8 hours in approximately 10% of cases. If this happens there will be a short segment of small bowel that will not be viewed by the capsule. If the capsule has not passed into the large bowel and you are not sure that the capsule has been passed you will need an x-ray to confirm passage.
· We believe the capsule is very accurate, but there may be a small chance the capsule endoscopy may miss a lesion. It may be necessary to repeat the procedure if there is sufficient concern that a lesion might have been missed.
· The risk of an unsuccessful or incomplete procedure is increased if you have swallowing difficulties or poor stomach emptying. The risk of the capsule getting stuck may be higher in patients with previous bowel surgery or bowel obstruction. Please tell us if you have a pacemaker or any of the above conditions.
Why do we need your informed consent?
You have the right to refuse any suggested examinations or treatment if you are not convinced that it is the best option for you. You can only make a sensible decision if you are fully informed.
What does this mean?
Your doctor will have told you about the proposed treatment, possible alternatives and any substantial risks, so that you can decide for yourself whether or not to agree to the capsule endoscopy. The information in this leaflet will also help you. Before signing the consent form you should be satisfied that you have been given all the information you require. Please feel free to discuss any aspect of the proposed examination with the nursing staff and myself. If you decide to go ahead you can change your mind at any time.
The Consent Form
Please read the attached consent form carefully as you will be asked to sign it on the day of the consultation prior to the procedure after further discussion if you wish. However, we must be sure that you agree with what is being proposed for you, and you will have to sign the consent form before we proceed. Please bring these documents and the consent form with you when you see me.
Capsule endoscopy is accurate in detecting serious problems of the small bowel. The complications are very rare.