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Pill makes endoscopy easy to swallow

Capsule transmits thousands of photographsas it works its way through digestive tract

Capsule transmits thousands of photographsas it works its way through digestive tract

November 12, 2007|By MARIE GILBERT

Studying and treating disorders of the digestive system might not be the most glamorous job.

But you'd never know it from talking with Dr. Fawaz Hakki, a gastroenterologist.

These days, he's feeling like a movie director.

The feature presentation? It's a full-color video of the tight, twisted tunnels of a patient's small intestine.

Welcome to real fantastic voyage, the story of a pill-sized camera that is making intestinal endoscopy easier to swallow.

"It's awesome technology," said Hakki, of Potomac Gastroenterology in Waynesboro, Pa. "In my opinion, it's the gold standard when it comes to examining the small intestine."

The procedure is called capsule endoscopy and, according to Hakki, it allows gastroenterologists to view pictures of the small intestine where bleeding, inflammation, lesions and other causes of abdominal pain might occur.

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Traditional exams don't always provide the information physicians are looking for when trying to make a diagnosis, Hakki said. And, most often, those procedures are invasive. With capsule endoscopy, specialists now have the ability to explore often unseen territory within a patient's small intestines - and all that is required of the patient is a glass of water and eight hours.

"It's safe and has very minimal discomfort," Hakki said. "It's absolutely great."

Capsule endoscopy is a breakthrough technology, originally developed in Israel, Hakki said. The capsule has been in use in the United States for about five years.

And while it is not a substitute for a regular endoscopy - a procedure in which long flexible tubes with lights are inserted through the mouth and into the digestive tract - it serves as an additional diagnostic tool for patients who have been suffering from unexplained gastrointestinal disorders. It also can be used to evaluate conditions of the small bowel that cause diarrhea, pain or weight loss.

The procedure enables physicians to look at 20 feet of the small intestine, not just the 4 to 5 feet that can be visualized with other types of endoscopy.

"By identifying conditions that traditional methods cannot visualize, we can more accurately determine the course of treatment for patients," Hakki said.

Approximately the size of a multivitamin, the capsule includes a miniature color video camera, light-emitting diodes, batteries and a transmitter, Hakki said.

Images captured by the camera are transmitted to a number of sensors attached to the patient's torso and recorded digitally on a recording device similar to a Walkman that is worn around the patient's waist.

According to Hakki, the patient swallows the capsule with a glass of water.

"Then you go about your daily activities," he said. "Go for a walk, go shopping, whatever."

After about eight hours - the time it takes for the capsule to move through the small intestine - the patient returns to the doctor's office, the recorder is removed from the patient and the information it contains is downloaded onto a computer for examination.

The capsule is naturally passed through the body in a dayor two.

Hakki said the capsule's camera takes an average of 50,000 pictures during the eight-hour period inside the small intestine.

"It's very exciting technology," he said. "I can look at the video, fast forward, zoom in on areas of concern. I feel like a movie director."

Hakki, who has been in Waynesboro for more than one year, said he used capsule endoscopy while working in Florida. He began to offer the procedure to area patients in the fall.

"I've talked to a few of my patients about capsule endoscopy, and they're thrilled with the idea of having a procedure that doesn't involve surgery," he said.

Hakki said the procedure costs between $800 and $900, which includes the capsule, facility fee and doctor's fee.

The procedure might be covered by health insurance, depending on the insurance company, what the physician is looking for and the diagnosis.

Capsule endoscopy is also available at the Endoscopy Center at Robinwood, a division of Washington County Health System.

According to Penny Nicarry, facility manager, the center offers the capsule endoscopy to its patients but emphasizes that it is not used as a first-line diagnostic test.

If a patient is having symptoms, an EGD (upper endoscopy), colonoscopy and small-bowel series are performed first, she said. If results are normal but symptoms continue, then a capsule is ordered.

Capsule endoscopy is not yet in use at City Hospital in Martinsburg, W.Va., according to a hospital spokesperson.

As a medical student, Hakki never envisioned the kind of technology that would be available to him today, he said.

"Medicine is always improving," he said.

Brands of the endoscopic capsule include PillCam and EndoCapsule.

Hakki said researchers are currently developing a colonoscopy pill, an imaging device similar to the capsule endoscopy, that will aid in the detection of colon polyps and colon cancer screening. It is expected to be in use in five to 10 years.

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