Video-capsul to replace colonoscopy?

Usually the gastroenterologist uses the endoscopy technik to explore the digestive track. He introduces through the mouth or the anus, a long tube with optical fibers, to film inside the digestive tract, to take samples or remove polyps or to plug up a damaged vessel. One talks about colonoscopy for the exploration of the large intestine (or colon) and enteroscopy for the small intestine.

But endoscopy presents some major disadvantages:

  • Without general anesthesia, it is sometimes unpleasant, and source of apprehension by patients;
  • Due to the length of the digestive system, some areas are difficult or impossible to explore like the small intestine;

In 2000, a video capsule was developed to facilitate the exploration of the digestive tract. This capsule was baptized “Pillcam”. The device comes in the form of a capsule containing a tiny camera and a light source, essential to illuminate the interior of the intestine. Once swallowed, the videocapsule naturally progresses inside the body, driven by the usual contractions of the gastrointestinal mucosa and gravity. The camera can record video images transmitted by telemetry to an external recorder that the patient wears on a belt. The person can continue to do about their business, including work, while the capsule explores his gut. The capsule is removed within 24 hours with the faeces.

The video capsule is used for the exploration of the small intestine. Its main indication is the search for the cause of bleeding, not discovered by conventional tests. It allows the gastroenterologist to examine the three portions (duodeum, jejunum, ileum) of a patients intestine and identify numerous pathologies present within the small intestine. It has become an important tool for evaluation of suspected diseases in the small bowel. The only contraindication: the narrowing of the small intestine, due to a inflammatory bowel disease, Crohn’s disease, or consequences of radiotherapy of the small intestine.

And since 2013, PillCam has been adapted to the exploration of the colon, which has a larger diameter than the small intestine. It requires the same preparation as a colonoscopy. The exploration of the colon with video capsule is performed only when the colonoscopy is contraindicated, was incomplete or refused by the patient. In addition, the video capsule does not allow to intervene on the injury that it has identified; concretly a patient who will be diagnosed with polyps should have a colonoscopy to have them removed.

For the moment Videocapsule therefore is not a substitute to the standard examination for the diagnosis of colon cancer. But as technology improves, capsule endoscopy of the colon may be used more in the future.

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