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PillCam Capsule Endoscopy

Indications & Risks

Indications

  • PillCam® ESO is intended for visualization of the esophageal mucosa
Contraindications
  • PillCam ESO is contraindicated in patients with swallowing disorders or with known or suspected GI obstructions, strictures, or fistulas based on the clinical picture or pre-procedure testing and profile
  • It is also contraindicated in patients with cardiac pacemakers or other implanted electromedical devices

Procedure Risks

There is a low risk of capsule retention associated with PillCam capsule endoscopy procedures.  Capsule retention is defined as having a capsule that remains in the digestive tract for more than two weeks.
 
Causes of retention cited in the literature include: NSAID strictures, Crohn’s disease, small bowel tumors, intestinal adhesions, ulcerations, and radiation enteritis. Summaries in published literature identify the risk of retention for obscure bleeding to be 1.5%;1 for suspected and known Crohn’s disease the pooled retention rate is 2.6%;1,2 and for neoplastic lesions, the rate of retention is 2.1%;2 as compared to healthy volunteers.
 
In cases where the patient fails to see passage of the capsule or the study does not show a clear exit of the capsule to the cecum, an x-ray may verify if the capsule is retained in the small bowel or passed into the colon.
 
There is a rare risk of capsule aspiration while patients are attempting to swallow a PillCam capsule.  There is also a low risk of skin irritation from the PillCam sensor array’s sleeve adhesive or silicone exposure.
 
The PillCam capsule may be administered by using transendoscopic delivery in patients who are either unable to ingest the capsule or who are known to have slow gastric emptying.  If using transendoscopic delivery, potential complications include, but are not limited to: perforation, hemorrhage, aspiration, fever, infection, hypertension, respiratory arrest, and cardiac arrhythmia or arrest.
 
Medical, endoscopic, or surgical intervention may be necessary to address any of these complications, should they occur.
After ingesting a PillCam capsule and until the capsule is excreted, patients should not be near any source of powerful electromagnetic fields, such as one created by an MRI device.
 
This information should not be used as a substitute for medical advice concerning specific diagnosis and treatment.
 
References
1Cave D et al. ICCE Consensus for Capsule Retention. Endoscopy 2005;37(10):1065-1067.
2Liao Z, Gao R, Xu C, Li ZS. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc. 2010;71(2):280-6.