International Journal of Research in Pharmaceutical and Biomedical Sciences

ISSN: 2229-3701

_________________________________________________________________________Review Paper

Camera Pill Endoscopy

Naga Raj.Y ___________________________________________________________________________________________
Abstract Camera Pill or Capsule endoscopy, is a new diagnostic tool that permits a direct visual examination of the small intestine, an area of the body not previously accessible using upper endoscopy from above or colonoscopy from below. The pill, known as the M2A Capsule Endoscopy, is about the size of a multivitamin and is swallowed with a sip of water. The pill is made of specially sealed biocompatible material that is resistant to stomach acid and powerful digestive enzymes and thus every care is taken such that the caps will not rupture or burst. Its non-invasive diagnostic alternative that is relatively quick, easy, office based test that will encourage people to see their doctors to get checked for diseases" Capsule endoscopy helps your doctor evaluate the small intestine. This part of the bowel cannot be reached by traditional upper endoscopy or by colonoscopy. The most common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine. It may also be useful for detecting polyps, inflammatory bowel disease (Crohns disease), ulcers, and tumors of the small intestine. Key words: Visual examination, Colonoscopy, Non-invasive, Endoscopy.

___________________________________________________________________________________________
INTRODUCTION The pill (developed at university of Washington) consists of 7optical fibers,one for illumination and the rest six for collecting light. once swallowed, electric current flows through the pill that causes the encased fibers to bounce back and forth such that its electronic eye would be able to scan the GI tract. The tip will iluminate red, green and blue laser light helping in visuality, all this processing together combined will give us two-dimensional picture helping in diagnosis.The images can be retrieved from the recording device worn around patient's waist as a belt.(2) All this is about the technical side, but how about the patient compliance??? at the end of the day, 'WE' are all here to make patient more comfortable..Yup, the patient is comfortable and convenient to swallow this large vitamin sized pill that can be taken with a mouthful of water. "Its non-invasive diagnostic alternative that is relatively quick, easy, office based test that will encourage people to see their doctors to get checked for diseases" said by Dr. Michael Brown, the gastroenterologist.(4) _______________________________________ *Address for correspondence: E-mail:nagarajzerik@gmail.com HISTORY: Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope Unlike most other medical imaging devices, endoscopes are inserted directly into the organ. Endoscopy can also refer to using a borescope An endoscope is a flexible camera that travels into the body's cavities to directly investigate the digestive tract, colon or throat. These tools are long, flexible cords about 9 mm wide, about the width of a human fingernail. Because the cord is so wide patients must be sedated during the scan. The tiny camera is like swallowing a pill attached to a string. The camera's 1.4-mm-thick tether allows the doctor to move the camera around and pull it back up once the five- or 10-minute test is finished An endoscope can consist of A rigid or flexible tube A light delivery system to illuminate the organ or object under inspection. The light source is normally outside the body and the light is typically directed via an optical fiber system A lens system transmitting the image to the viewer from the fiberscopean additional channel to allow entry of medical instruments or manipulators 872

Vol. 2 (3) Jul Sep 2011

www.ijrpbsonline.com

International Journal of Research in Pharmaceutical and Biomedical Sciences

ISSN: 2229-3701

CAPSULE ENDOSCOPY: The procedure, called capsule endoscopy, has proven to be effective in aiding diagnosis of previously undetectable abnormalities in the small intestine that commonly result in gastrointestinal bleeding Capsule Endoscopy lets your doctor examine the lining of the middle part of your gastrointestinal tract, which includes the three portions of the small intestine (duodenum, jejunum, ileum). Your doctor will give you a pill sized video camera for you to swallow. This camera has its own light source and takes pictures of your small intestine as it passes through. These pictures are sent to a small recording device you have to wear on your body. Your doctor will be able to view these pictures at a later time and might be able to provide you with useful information regarding your small intestine. Capsule endoscopy helps your doctor evaluate the small intestine. This part of the bowel cannot be reached by traditional upper endoscopy or by colonoscopy. The most common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine. It may also be useful for detecting polyps, inflammatory bowel disease (Crohns disease), ulcers, and tumors of the small intestine. As is the case with most new diagnostic procedures, not all insurance companies are currently reimbursing for this procedure. You may need to check with your own insurance company to ensure that this is a covered benefit Capsule enteroscopy allows your doctor to visualise the small intestine which is often missed by conventional imaging methods such as upper gastrointestinal endoscopy or colonoscopy. The most common reason for ordering this investigation is to look for sources of bleeding. You may have noticed blood in your vomit or faeces, or have unnoticed blood loss that can cause iron deficiency anaemia. This investigation can identify polyps, inflammatory bowel disease (Crohn's disease or ulcerative colitis), ulcers and tumours that may be the source of the bleeding. Such lesions may not have been found by previous investigations but once identified, your doctor can decide an appropriate course of management. The other main use is for evaluating the extent of Crohn's disease, which commonly affects the small intestine. This investigation is particulary useful for detecting early disease which may be missed by barium examination and computed tomography (CT). Also it can be useful in patients who have

symptoms which do not match the extent of disease (if any) seen by conventional imaging techniques. Wireless capsule enteroscopy may have further indications in the future as it is safe, easy to perform, non-invasive and doesn't require sedation. In particular, if techniques are invented that allow treatments or biopsies (tissue sampling) to be performed at the time of procedure, it will become a very useful procedure. It should be noted that this investigation may not always be the best for you. The images taken by the camera are of poorer quality than those obtained by upper gastrointestinal endoscopy or colonoscopy. In addition, the camera may move too fast or slow to examine or the appropriate areas or be facing the wrong way and miss some lesions. Thus, it is only one possibility of a series of investigations you may require in order for your doctor to make a correct diagnosis. PROCEDURE: You will get a belt with a recorder to wear it around your waist. You will swallow a camera that will enter your bowel and take over 50,000 pictures of the inside layer (mucosa) of your small intestine. Pictures will be continuously sending via wireless route (radio waves) to the recorder for 8 hours. You will not be allowed to run or exercise during this time but you will be able to freely walk around. Two hours after swallowing the camera, you will be allowed to start to drink and after four hours to eat. When the camera will enter the large intestine it will still take some time (12 to 72 hours but usually within 24 hours after swallowing) to be excreted with the stool. You will not need to return a camera to the doctor. No fluid is taken for at least 2 hours and no food for a further 4 hours after swallowing the capsule. Oral medications can be taken after 2 hours if required. If you are diabetic, the medication must be stopped during the fasting period and insulin use should be discussed with your doctor Capsule enteroscopy is a safe procedure and is well tolerated by most patients. Less than 1 in 10 people have difficulty swallowing the capsule, which has a gel coating to help you swallow it. The main risk is retention of the capsule, which occurs in about 1 in a hundred people. The capsule 873

Vol. 2 (3) Jul Sep 2011

www.ijrpbsonline.com

International Journal of Research in Pharmaceutical and Biomedical Sciences

ISSN: 2229-3701

becomes impeded by a stricture (narrowing) secondary to a tumour, inflammation or scarring from previous surgery. It is not dangerous in the short term, but you may require a surgical intervention to remove it. Obstruction may present as bloating, vomiting or pain. You should consult your doctor promptly if you experience these symptoms. In most cases the capsule will pass naturally from the body without any problems. Drugs used in the treatment of this symptom: Docusate sodium; Sennosides A and B (Coloxyl with Senna) Sennosides A and B (Laxettes with Senna) Sodium picosulfate (Picolax) Citric acid; Magnesium oxide; Sodium picosulfate (PicoPrep) Ascorbic acid; Citric acid; Magnesium oxide; Potassium chloride; Sodium chloride; Sodium picosulfate; Sodium sulfate (Prep Kit C) Diseases which use this investigation: Colonic polyps and hereditary polyposis syndromes Crohn's disease (Inflammatory Bowel Disease) Peptic Ulcer Disease (PUD) COMPONENTS OF WIRELESS ENDOSCOPY: The capsule endoscopy system: The capsule endoscopy system is composed of several key parts: The capsule(Camera pill) A portable image receiver/recorder unit Battery pack Specially modified computer workstation . Wireless Endoscopy Capsule: The imaging capsule is 11 mm by 26 mm, is pill shaped, and contains these miniaturized elements: a battery, a lens, four light-emitting diodes, and an antenna/transmitter. the capsule is sealed and resistant to decay within the gut.the capsule comes from the manufacturer ready to use and activated on removal from a holding assembly, which contains a magnet that keeps the capsule inactive until use. Once activated, the capsule begins to

record images at a rate of 2 per second and transmit them to the belt-pack receiver. The capsule continues to record images at this rate over the course of the 7-8 hour image acquisition period, yielding a total of approximately 50,000 images per examination. The capsules lens is hemispheric and yields a 140-degree field of view, similar to that of a standard endoscope. The capsule is disposable and doesnt need to be recovered by the patient or medical personnel. Receiver/Recorder Unit: In order for the images obtained and transmitted by the capsule endoscope to be useful, they must be received and recorded for study. Patients undergoing capsule endoscopy wear an antenna array consisting of 8 leads that are , connected by wires to the recording unit, worn in standard locations over the abdomen, as dictated by a template for lead placement. The antenna array is very similar concept and practice to the multiple leads that must be affixed to the chest of patients undergoing standard 12-lead electrocardiography. The antenna array and battery pack can be worn under regular clothing. The recording device to which the leads are attached is capable of recording the thousands of images transmitted by the capsule and received by the antenna array. Ambulatory(non-vigorous) patient movement doesnt interfere with image acquisition and recording. A typical capsule endoscopy examination takes approximately 7 hours. Computer Workstation: Once the patient has completed the endoscopy examination, the antenna array and recording device are returned to the health care provider. The recording device is then attached to a specially modified to a computer workstation, and the entire examination is downloaded into the computer, where it becomes available to the physician as a digital video. Working o f the Endoscopic Camera in a Pill The tiniest endoscope yet takes 30 two-megapixel images per second and offloads them wirelessly. See how it works inside the body in an animation Sayaka Endoscope Capsule In situ, in your gut Medi-Mation Pop this pill, and eight hours later, doctors can examine a high-resolution video of your intestines for tumors and other problems, thanks to a new spinning camera that captures images in 360 degrees.

874

Vol. 2 (3) Jul Sep 2011

www.ijrpbsonline.com

International Journal of Research in Pharmaceutical and Biomedical Sciences

ISSN: 2229-3701

How the Pill Films Your Innards Easy Pill to Swallow: The Sayaka is 40 percent smaller than previous endoscope cameras Luis Bruno Down_the_Hatch The patient gulps down the capsule, and the digestive process begins. Over the next eight hours, the pill travels passively down the esophagus and through roughly 20 to 25 feet of intestines, where it will capture up to 870,000 images. The patient feels nothing. Power_Up The Sayaka doesnt need a motor to move through your gut, but it does require 50 milliwatts to run its camera, lights and computer. Batteries would be too bulky, so the cam draws its power through induction charging. A vest worn by the patient contains a coil that continuously transmits power. Start_Snapping When it reaches the intestines, the Sayaka cam begins capturing 30 two-megapixel images per second (twice the resolution of other pill cams). Fluorescent and white LEDs in the pill illuminate the tissue walls. Spin-for_close-Ups Previous pill cameras place the camera at one end, facing forward, so the tissue walls are visible only in the periphery of their photos. Sayaka is the first that gets a clearer picture by mounting the camera facing the side and spinning 360 degrees so that it shoots directly at the tissue walls. As the outer capsule travels through the gut, an electromagnet inside the pill reverses its polarity. This causes a permanent magnet to turn the inner capsule and the image sensor 60 degrees every two seconds. It completes a full swing every 12 secondsplenty of time for repeated close-ups, since the capsule takes about two minutes to travel one inch. Offload-Data Instead of storing each two-megapixel image internally, Sayaka continually transmits shots wirelessly to an antenna in the vest, where they are saved to a standard SD memory card. Deliver-Video Doctors pop the SD card into a PC, and software compiles thousands of overlapping images into a flat map of the intestines that can be as large as 1,175 megapixels. Doctors can replay the ride as video and magnify a problem area up to 75-fold to study details.

Leaves_the_Body At around $100, the cam is disposable, so patients can simply flush it away. the images from the camera pill will be retrieved from the recording device worn around patient's waist as a belt radio frequency waves are the one transmitting the pictures..but, once a while exposure will not cause the side effects or adverse effects..its not a daily treatment or monthly ones. TYPES O F CAMERA PILLS: The reason is that camera only takes about three or four seconds to make its way through the esophagus producing two to four images per second and once it reaches the stomach, its roughly five-gram weight causes it to drop very quickly to the lower wall of the stomach. In other words, it is too fast to deliver usable images. For examinations of the esophagus and the stomach, therefore, patients still have to swallow a rather thick endoscope. Sankt Ingbert have developed the first-ever control system for the camera pill. In future, doctors will be able to stop the camera in the esophagus, move it up and down and turn it, and thus adjust the angle of the camera as required, says IBMT team leader Dr. Frank Volke THE ADVANCED VERSIONS: "SPIDER PILL": One disadvantage of the camera pill is that its movement cannot be controlled by the physician, the pill blindly follws the gastric transit time, this is overcomed by "spider pill". Once swallowed, the pill's tiny legs would be activated by wireless radio by the physician such that the pill crawls inside the GI tract like that of spider. after the examination is done the spider(pill) legs are withdrawn and is allowed for excretion naturally.(5) Well, there are around 4-5 legs for a spider both in the front and back.. there is a radio wave frequency receiver in the pill that receives the wave signal and opens the legs either the front ones or the back ones as per the command given by the operator (physician rather) and crawls like a spider... "MAGNET-CONTROLLED PILL": ts a device whose motion can be controlled by doctor by moving magnets accordingly." the doctor can hold it in hand during examination and move it 875

Vol. 2 (3) Jul Sep 2011

www.ijrpbsonline.com

International Journal of Research in Pharmaceutical and Biomedical Sciences

ISSN: 2229-3701

up and down the patient's body. The camera inside follows the motion precisely Magnet-Controlled Camera In The Body Images from inside the body? It can be done with tiny cameras which the patient has to swallow. In the past there was no way of controlling the device as it passed through the body. Now it can be steered and stopped where desired, and even deliver images of the esophagus. This allows them to make a precise examination of the junction between the esophagus and the stomach, for if the cardiac sphincter is not functioning properly, gastric acid comes up the esophagus and causes heartburn. In the long term, this may even cause cancer of the esophagus. Now, with the camera, we can even scan the stomach walls. But how do the researchers manage to steer the disposable camera inside the body? We have developed a magnetic device roughly the size of a bar of chocolate. The doctor can hold it in his hand during the examination and move it up and down the patients body. The camera inside follows this motion precisely, says Volke. The camera pill is not larger than a candy. It can be swallowed by the patient. The doctor steers it through esophagus and stomach by a magnetic device. Contraindications to Capsule Endoscopy Most gastroenterologists consider capsule endoscopy to be contraindicated inpatients with suspected small-bowel strictures (e.g., from Crohn'sdisease or prior bowel surgery), swallowing disorders, motilitydisorders, intestinal pseudoobstruction. A relativecontraindication may exist in patients with esophageal, small-bowel,or colonic diverticula, and in patients with implantable pacemakers,defibrillators, or other electronic devices, although reportshave challenged many of these guidelines LIMITATIONS: Brown cautions the pill camera is not for everyone. People with swallowing disorders, pacemakers or with known or suspected gastrointestinal obstruction, strictures, or fistulas are not candidates. Brown says the public may be familiar with the camera pill used for the small bowel/intestine ADVANTAGES: The pill isnt 100 percent successful because, due to its small size, the camera can capture an image

of only about 70 percent of the digestive tract at any one point, he said.Using the scanning device is cheap because it's so small it doesn't require anesthesia and sedation, which increase the cost of the traditional procedure In addition to its size, the main advantage of this invention is its cost a few hundred dollars compared to more than $5,000 for the standard scope. Also, unlike traditional endoscopy, the procedure requires no sedation, and patients can resume normal activity immediatelymarketed for esophageal cancer screening Maneuvering human body without disturbing it much is an effective way of treatment or diagnosis. DISADVANTAGES: The pill isnt 100 percent successful because, due to its small size, the camera can capture an image of only about 70 percent of the digestive tractat any one point It allow only a single fly-by view It is just a diagnostic tool..no any therapeutic use Clinical applications: Gastrointestinal bleeding Studies evaluating capsule endoscopy alone. capsule endoscopy has been most widely used in patients with chronic gastrointestinal blood loss of unclear origin in whom standard investigations have not been diagnostic. Over the past year, a large amount of data has become available with regard to the outcome of patients in this situation who underwent capsule endoscopy Capsule Endoscopy versus Push Enteroscopy: Compared the findings of capsule endoscopy to push enteroscopy in 20 patients with obscure gastrointestinal bleeding, all of whom had negative results on atlest one upper or lower endoscopy or small bowel radiography. A positive finding was identified during capsule endoscopy in 11 patients Inflammatory bowel disease/Crohns disease or ulcerative colitis:In most patients with true inflammatory bowel disease(crohns disease or ulcerative colitis), the diagnosis is reached using a combination of upper and lower endoscopy, barium studies and blood tests. There does exist, however, a small subset of patients in whom the clinical suspicion for inflammatory bowel disease is high and yet results of these tests are negative or normal. It was reported 3patients in whom afore mentioned evaluations were negative who were find via capsule endoscopy to have crohns disease. Post surgical monitoring following small bowel transplantation: Patients undergoing small bowel transplantation typically have an end-ileostomy 876

Vol. 2 (3) Jul Sep 2011

www.ijrpbsonline.com

International Journal of Research in Pharmaceutical and Biomedical Sciences

ISSN: 2229-3701

created at the time of surgery. Traditionally, these patients have been monitored for healing, villous recovery, and development of such complications as graft-verus host disease by ileoscopy and biopsy using standard endoscopes. Capsule studies were able to clearly document the time-appropriate changes that would be expected in these patients Oesophageal Cancer Screening: In the past 30 years diagnoses of esophageal cancer have more than tripled. The esophagus is the section of digestive tract that moves food from the throat down to the stomach. Esophageal cancer often follows a condition called Barrett's esophagus, a noticeable change in the esophageal lining. Patients with Barrett's esophagus can be healed, avoiding the deadly esophageal cancer. But because internal scans are expensive most people don't find out they have the condition until it's progressed to cancer, and by that stage the survival rate is less than 15 percent. - A new camera-in-a-pill can help doctors diagnose and evaluate diseases of the esophagus including gastroesophageal reflux disease (GERD), erosive esophagitis and Barrett's esophagus (a precancerous condition) without the use of a traditional endoscope. GERD sufferers are often treated with prescription or over-the-counter antacids. However, treatments that control symptoms do not prevent the development of more serious complications. "Millions of people are chronic antacid users and have never been evaluated for esophageal disease,"

says Brown. "We think that the pill camera will make it easier for people at risk to get that evaluation sooner and keep esophageal disease in check Conclusions: In this study capsule endoscopy was superior to push enteroscopy in the diagnosis of recurrent bleeding in patients who had a negative gastroscopy and colonoscopy. It was safe and well tolerated Wireless capsule endoscopy represents a significant technical breakthrough for the investigation of the small bowel, especially in light of the shortcomings of other available techniques to image this region. The capsule endoscopy seems best suited to patients with gastrointestinal bleeding of unclear etiology who have had nondiagnostic traditional testing and in whom the distal small bowel(beyond reach of a push enteroscope) needs to be visualized

877

Vol. 2 (3) Jul Sep 2011

www.ijrpbsonline.com

International Journal of Research in Pharmaceutical and Biomedical Sciences

ISSN: 2229-3701

Spider pill

Magnet-Controlled Camera pill

878

Vol. 2 (3) Jul Sep 2011

www.ijrpbsonline.com

International Journal of Research in Pharmaceutical and Biomedical Sciences

ISSN: 2229-3701

REFERENCES 1. news.bbc.co.uk.[homepage on the internet] . "Spider pill " used for scans. updated on oct 11th 2009. Available from: http://news.bbc.co.uk/2/hi/science/nature/ 8301232.stm. sciencedaily[homepage on the internet]. Magnet Controlled Camera In The Body. Upated on jun 9th 2008. Available from: http://www.sciencedaily.com/releases/200 8/06/080603105634.htm. Mylonaki M, et al. "Wireless capsule endoscopy: a comparison with push enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleeding". Gut, "Capsule endoscopy turning up undiagnosed cases of Crohn's disease". Physorg.com Pink Tentacle. "Sayaka: Next-generation capsule endoscope". Chong A, Taylor A, Miller A, Desmond P. Initial experience with capsule endoscopy at a major referral hospital. MJA 2003; 178 (11): 537-40. Available [online] at URL: http://www.mja.com.au/public/issues/178 _11_020603/cho10606_fm.html Hara A, Leighton J, Sharma V, Heigh R, Fleischer D. Imaging of small bowel disease: comparison of capsule endoscopy, standard endoscopy, barium examination, and CT. RadioGraphics 2005; 25: 697-711. 8. Sidhu RR, McAlindon MEME, Sanders DSDS, Thomson MM. Capsule endoscopy in the evaluation of gastrointestinal disease. Current Opinion in Pediatrics. 2007; 19(5): 586-90. 9. van Tuyl SSAC, Kuipers EEJ, Timmer RR, Stolk MMFJ. Video capsule endoscopy: procedure, indications and diagnostic yield. Netherlands Journal of Medicine. 2004; 1. Galmiche JP, Coron E, Sacher-Huvelin S. Recent developments in capsule endoscopy. Gut. 2008;57:695 703. [PubMed] 10. Rondonotti E, Villa F, Mulder CJ, Jacobs MA, de Franchis R. Small bowel capsule endoscopy in 2007: indications, risks and limitations. World J Gastroenterol. 2007;13:61406149. [PubMed] 11. Fernandez-Urien I, Carretero C, Sola JJ, Munoz-Navas M, Betes M, Subtil JC, Armendariz R. Refractory Whipple's disease. Gastrointest Endosc. 2007;65:521522, discussion 522. [PubMed]

2.

3.

4.

5. 6.

7.

879

Vol. 2 (3) Jul Sep 2011

www.ijrpbsonline.com