Video capsule (small bowel examination)

A small bowel video capsule is a procedure that allows the inside of the small bowel to be viewed. The procedure is performed using a small camera built into a capsule (approximately 15 mm). You swallow the wireless video capsule just like a pill, and the camera takes a picture twice per second. These images are transmitted to a device that you carry in a pouch during the exam. The capsule travels through your entire gastrointestinal tract via normal bowel movements. Usually, the video capsule leaves your body with your stool within 3 to 30 hours.

This test can detect abnormalities in the small intestine.

• The doctor may recommend this test if he suspects an abnormality in the small intestine or if there is unexplained blood loss. Unexplained blood loss is defined as blood loss for which no abnormalities have been found elsewhere in the gastrointestinal tract following stomach and intestinal examinations, and which is accompanied by iron-deficiency anemia.
• Using the video capsule, the doctor can detect the following conditions, among others: ulcers or inflammation in the small intestine (e.g., Crohn's disease), tumors or polyps in the small intestine, bleeding in the small intestine, and other conditions.

You should stop taking iron supplements one week before the exam. These supplements turn the intestines black, which can make the images unclear. After the exam, you may resume taking your iron supplements as before.

Medications that slow down bowel movements, such as codeine or loperamide (Imodium®), should also be temporarily discontinued.

The night before the video capsule exam, you may have a light meal, such as toast and yogurt.

You will also be expected to take a bowel preparation. This preparation can be done using the product Plenvu.

• Mix dose 2 (sachets A and B) with ½ liter (500 ml) of fresh water.
• Drink this product alternately with 1 liter of plain water.
• Drink the liquids within 1 hour to 1 hour and 15 minutes.

• You may take your medication up to 2 hours before the test, in consultation with your doctor. If you have diabetes, please contact your doctor regarding any necessary adjustments to your medication dosage: after all, you will not be eating for a while, and if your dosage is not adjusted, there is a risk of your blood sugar level dropping too low.
• You must arrive at the examination on an empty stomach.

• The examination is conducted on an outpatient basis.
• A belt with a sensor is fastened around your abdomen, and the images captured are transmitted to the recorder, which you carry in a small bag.
• Swallow the video capsule with a small amount of water.
• In cases of known or suspected gastroparesis (delayed gastric emptying) and swallowing difficulties, the capsule is inserted endoscopically. If, after some time, the capsule still appears to be in the stomach, a gastric examination is sometimes performed to move it into the small intestine.
• After taking the capsule, you should wait 4 hours before eating a light meal.
• You are expected to return to the endoscopy unit at 5:30 p.m. to have the sensor and pouch removed; once the recorder has been removed, you may eat as usual.

Disadvantage

• The video capsule is expensive. It also takes a lot of time to review and analyze all the images. The capsule is not fully reimbursed. Part of the cost is covered by health insurance, and part (200 euros) is paid by the patient. A price estimate can be requested from the billing department via factuur@azdelta.beor 051 23 70 54.
• Another major drawback of this procedure is that the doctor cannot take tissue samples for examination. Polyps also cannot be removed immediately during the procedure. If an abnormality is found in the small intestine during a video capsule examination, a small intestine endoscopy (enteroscopy) or keyhole surgery is often still necessary.

Benefit

• One advantage of the video capsule is that it is a painless and non-invasive examination for the patient. This examination can also provide information about conditions that would otherwise remain undetected.

If there is a narrowing in the gastrointestinal tract, the capsule may become lodged there and cause an obstruction (< 1%). You should always inform your doctor if you have had previous abdominal surgery or have had an obstruction in the past. During the examination, you must not undergo an MRI (magnetic resonance imaging) scan and should avoid strong magnetic fields. If you have any questions, please consult your gastroenterologist.