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I have heard that there is camera that can show the entire gastrointestinal system. Should I get this test as part of work-up for IBS?

Dr. Farhadi: Pillcam ® is a very small camera that can fit into a pill size capsule and can record images of the entire stomach and the small bowel. The Pillcam® is ingested similar to a regular pill. The name of this test is Video Capsule Endoscopy and is currently being performed in many centers throughout the world. The camera inside the capsule is equipped with a light source that will be used to illuminate the inside of the bowel during the image capture. The images that are captured by the camera will be transmitted through a wireless technology to a small pager like device that is worn around your belt. Thus, there is no need to retrieve the capsule to obtain the images. The Pillcam® capsule is disposable and the battery inside the capsule wears out after a few hours of use. The Pillcam® capsule records 2 images per second for 8 hours continuously (almost 50,000 images). After completion of the test (8 hours) the images will be downloaded from the device into the physician’s desk-top computer for viewing. Playing these images on the computer create a near continuous motion picture like a movie. This procedure does not require prior bowel cleansing or preparation and during the test you can go back to your daily routine. In addition, this test is painless and minimally invasive with very few complications. However, there are some limitations to this test. First of all this test only is designed to diagnose lesions in the stomach and small bowel. This is due to the fact that large bowel always contains fecal material and the test is done without any pre-procedure bowel cleansing. Not to mention that the large bowel is easily accessible to colonoscopy. Additionally, there is no way to control the camera’s views or speed of passage through various part of the GI tracts, as the main force for forward movement of the Pillcam® capsule is gastrointestinal motility. Therefore, there could be a great variation in the speed of the passage of the camera and speed of recording of the images by the camera. Lastly, the lack of therapeutic capabilities on the device can mandate further endoscopic intervention for obtaining tissue or treatment of the lesions that are located using the Pillcam®. Overall, this useful test is becoming increasingly popular because of ease of use and minimal invasiveness. The test is currently being used to diagnose several gastrointestinal disorders including celiac disease, small bowel Crohn’s disease and benign or malignant tumors of the small bowel. This is particularly important because this part of the bowel is less accessible to conventional endoscopic examination. Currently, this test is not indicated to be performed routinely in patients with IBS. However, those with chronic abdominal pain in whom the diagnosis of small bowel Crohn’s disease or celiac disease are likely may benefit from this diagnostic capability of this test.
2007-12-25 01:38:38


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