Capsule endoscopy
The capsule endoscopy is an imagined in 2000 and 2001 for the first time commonly employed imaging technique to show the mucosa of the digestive tract using a swallowable camera capsule ( Pill-Cam ). On its way through the gastrointestinal tract, the capsule automatically takes pictures of the mucous membrane of the digestive tract and sends them out to a portable data recorder. The images can later be assessed for pathological changes by an appropriately trained doctor.
Development history
The video capsule was developed and patented for use in human medicine by the Israeli engineer Gavriel Iddan during his work at RAFAEL Advanced Defense Systems Ltd., a research and development department of the Israeli Ministry of Defense. After the capsule endoscopy was first described in 2000, received CE certification for Europe and approved by the US Food and Drug Administration ( FDA ), Given Imaging Ltd, Jokne'am , Israel, made it clinical in 2001 Use brought. There are now several manufacturers of camera capsule systems, as well as different types of camera capsules, which have been specially developed and are designed for examining the esophagus, the stomach, and the small and large intestines. So if the method was originally developed to examine the small intestine, which was previously difficult to access endoscopically, today all sections of the gastrointestinal tract can be examined by capsule endoscopy.
Capsule endoscopy of the esophagus and stomach
The capsule endoscopy of the esophagus has not been able to establish itself in everyday clinical practice compared to the conventional mirror examination, which is usually easy to carry out and unproblematic.
For the sole examination of the stomach, there is the so-called magnet-guided capsule endoscopy (capsule can be placed on the desired stomach section by means of magnetic guidance). This method has so far been tested in clinical studies and, like capsule endoscopy of the esophagus, has not yet found its way into clinical routine.
Capsule endoscopy of the small and large intestine
In contrast to capsule endoscopy of the esophagus and stomach, capsule endoscopy of the small intestine has acquired a permanent position in diagnostics, and large intestine capsule endoscopy is on the way there.
Technique of small and large intestine capsule endoscopy
The video capsule for the small intestine (shown here is the PillCam SB from Given Imaging) is a free-floating, tiny digital camera that measures approx. 26 mm in length and approx. 11 mm in diameter, including lighting, control and transmission electronics and the batteries. The latest generation of capsules adapts the image recording frequency to the speed at which the camera capsule moves in the intestine: at slow speeds, two images per second are recorded, while in fast passages six images per second are recorded. This is done with a recording angle of 156 °. The smallest detectable object has a size of 0.7 mm. The battery capacity guarantees an exposure / examination time of more than 11 hours. The colon video capsule has two camera heads: one on each end. This makes it easier to visualize areas behind wrinkles that are more difficult to see with other methods. Both camera heads have a recording angle of 172 ° each, so that almost all-round visibility is possible. The image acquisition frequency varies depending on the speed at which the camera capsule moves in the intestine, between 4 and 35 images per second.
Performing small and large intestinal capsule endoscopy
Thorough colon cleansing is necessary before beginning a capsule endoscopy. The capsule is swallowed, and during its six to eight-hour journey through the digestive tract, it records images of the inside of the intestine, which are sent by radio to a battery-powered receiver and storage unit carried on the body. The patient can move freely while taking the 50 to 60,000 images. The images are later combined into a video stream using special software and evaluated by a doctor. The capsule is only used once. The examination does not require ionizing radiation . No sedatives or narcotics have to be given. During the examination with the large intestine capsule, the patient drinks a special liquid once or twice during the passage of the capsule so that the capsule reaches the large intestine more quickly.
Indications for small bowel capsule endoscopy
Small bowel capsule endoscopy has established itself as the diagnostic gold standard for assessing the small bowel. According to the recommendations of the German Society for Digestive and Metabolic Diseases (DGVS), the use of the small intestine capsule can in principle be indicated whenever a small intestinal disease is suspected. The most important indication, however, is the clarification of intestinal bleeding from neither the stomach nor the large intestine (so-called medium gastrointestinal bleeding). In recent years, capsule endoscopy has also become established for patients with suspected or known Crohn's disease in certain questions. Other possible indications are polyposis syndromes, celiac disease and some other diseases of the small intestine.
Indications for colon capsule endoscopy
In its 2012 guideline, the European Society for Gastroenterology (ESGE) recommends the use of colon capsule endoscopy in patients for whom a complete conventional colonoscopy was not possible, as well as in patients who are at increased risk of bleeding, intestinal injuries or when using sedatives - / narcotics is present. In Japan, examination with the colon capsule will be approved for all indications from 2014, especially if patients are unable or unwilling to undergo conventional colonoscopy. There is no instrumental examination in the genital area, which takes into account the shame of many people. The camera capsule is a sterile, disposable item that is discarded after the examination. That, too, can be a reason for many to opt for capsule colonoscopy. As a particularly patient-friendly procedure, it has the potential to increase the willingness to participate in colon cancer screening, which was shown in a German screening study in 2009. However, any polyps cannot be removed immediately and tissue samples cannot be taken, as is possible with a conventional colonoscopy. This must be considered when deciding whether or not to have a colon capsule endoscopy.
Contraindications to capsule endoscopy
The most important contraindication for capsule endoscopy is a known or suspected pathological bottleneck in the digestive tract (stenosis) that could obstruct the capsule passage. If capsule endoscopy is to be performed despite a possible constriction in the intestine, the patency of the intestine for the camera capsule can be checked with a test capsule (patency capsule). It is identical in shape and size to the small intestine camera capsule, but after about 30 hours in the intestine it dissolves into small individual parts that could easily pass through any constrictions. The excretion of the intact capsule indicates the patency of the intestine and the possibility of performing a capsule endoscopy. Further contraindications are swallowing disorders ( risk of aspiration ), pregnancy and the simultaneous implementation of magnetic resonance imaging (MRI examination). The capsule is not approved for children under 2 years of age.
Reimbursement situation
Small bowel capsule endoscopy
The costs of a small bowel capsule endoscopy for inpatients are reimbursed via the DRG system. In the outpatient sector, private health insurances have been taking over the examination costs for clarifying unclear bleeding from the gastrointestinal tract since 2005. In the case of other indications, an individual application must be submitted to the health insurance fund, which, however, usually approves it in the event of medically justified use. The statutory health insurance companies have been paying the examination costs since 2011 to search for sources of bleeding in the small intestine and to clarify iron deficiency anemia .,
Colon capsule endoscopy
The costs for colon capsule endoscopy are also reimbursed for inpatient hospital patients via the DRG system. There are still no general rules for outpatient use; Health insurances and private health insurances only cover the costs in medically justified cases in exceptional cases.
Competing and Complementary Methods
Small intestine examination
The small intestine can also be examined with balloon enteroscopy , which enables diagnostic and therapeutic measures to be taken even in deeper sections of the small intestine (which cannot be reached with a gastric mirror). However, this method is very time-consuming and can be very stressful for the patient. Therefore, capsule endoscopically in advance of this examination, it is usually clarified whether a balloon enteroscopy is even necessary and how the examination should take place (through the mouth, esophagus and stomach or from below through anus, rectum and large intestine). Compared with radiological procedures (conventional enteroclysis , computed tomography , magnetic resonance tomography ), capsule endoscopy shows a significantly higher accuracy (sensitivity) for changes in the small intestinal mucosa, which is why the radiological procedures for small intestine examination (as well as ultrasound examination of the small intestine) are only used in very specific, rather rare cases Cases are used.
Colon Exam
The standard examination of the large intestine is a conventional colonoscopy for suspected or even probable colon disease . Other methods in exceptional cases are sonography and virtual colonoscopy (CT and MRI). Stool and blood tests with varying degrees of sensitivity are also used for the early detection of colon cancer . Colon capsule endoscopy already has a well-founded role in the diagnosis of colon disease in individual cases and has also shown in an initial study that it can significantly increase the acceptance of colon cancer screening among the population.
Individual evidence
- ↑ a b c d e f Position paper on small intestine capsule endoscopy of the German Society for Digestive and Metabolic Diseases from 2010 Archived copy ( memento of the original from March 4, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , last accessed December 27, 2015
- ↑ Given Imaging website http://www.givenimaging.com/de/Innovative-Solutions/Capsule-Endoscopy/Seiten/default.aspx , last accessed on March 17, 2013
- ↑ The journey into the self becomes reality: Siemens Healthcare and Olympus Medical Systems are developing a new system for gentle gastroscopy with magnetic control, Siemens Healthcare Sector press release, accessed April 30, 2010
- ↑ Feasibility of stomach exploration with a guided capsule endoscope, Rey, JF; Ogata, H .; Hosoe, N .; Ohtsuka, K .; Ogata, N .; Ikeda, K .; Aihara, H .; Pangtay, I .; Hibi, T .; Kudo, S .; Tajiri, H .: Endoscopy , 2010 Jul; 42 (7): 541-545
- ↑ Blinded nonrandomized comparative study of gastric examination with a magnetically guidedcapsule endoscope and standard videoendoscope, Rey, JF; Ogata, H .; Hosoe, N .; Ohtsuka, K .; Ogata, N .; Ikeda, K .; Aihara, H .; Pangtay, I .; Hibi, T .; Kudo, S .; Tajiri, H .: Gastrointestinal Endoscopy , 2012 Feb; 75 (2): 373-381
- ↑ What's in the PillCam COLON - VidiColon. (No longer available online.) Archived from the original on March 24, 2017 ; accessed on March 23, 2017 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ User Manual PillCam Capsule Endoscopy RAPID v8.0, DOC-2044-02, March 2013, p. 189
- ↑ a b c d patient information page of the Professional Association of German Internists http://www.internisten-im-netz.de/de_kapselendoskopie-durchfuehrung_1776.html , last accessed on March 17, 2013
- ↑ Guideline on Colon Capsule Endoscopy of the European Society for Gastroenterology ( Memento of the original from March 5, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF file; 133 kB), last accessed on March 17, 2013
- ↑ Press release Given Imaging Ltd., Israel, dated November 11, 2013
- ↑ Capsule colonoscopy increases uptake of colorectal cancer screening BMC Gastroenterologym 12, Article number: 80 (2012), biomedcentral.com, preventive study on colon capsule endoscopy of the University Medical Center Hamburg-Eppendorf, accessed January 26, 2020 (English)
- ↑ Information page of the VidiColon Doctors Association for colorectal cancer screening ( memento of the original from May 13, 2013 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. , last accessed March 17, 2013
- ↑ Patient information page of the Felix Burda Foundation , last accessed on March 17, 2013
- ^ Reimbursement decision of the Federal Joint Committee (GBA) on small intestinal capsule endoscopy http://www.g-ba.de/informationen/beschluesse/1233/ , last accessed on March 17, 2013
- ↑ a b c Güldütuna, SG; Keuchel, M. et a .; Practical Guide to Capsule Endoscopy; 2nd Edition; UNIMED publishing house; 2012
