CAPSULE ENDOSCOPY Kendall Yoshisato, RN, CGRN Northern CA SGNA September 22, 2012

CAPSULE ENDOSCOPY

Kendall Yoshisato, RN, CGRNNorthern CA SGNASeptember 22, 2012

OBJECTIVES

Understand the history of small bowel exploration

Review the indications for capsule studies

Discuss the nursing assessment/education for capsule endoscope

Describe the role of the nurse reviewer

Capsule Endoscopy

History of Small Bowel Imaging Radiology

Small Bowel Follow Thru Angiograms Tagged Red Blood Cell Studies

Capsule Endoscopy History of Small Bowel Exploration

Use of colonoscopes Sonde Enteroscopes Development of push enteroscopes Capsule Endoscopy (2001)

Given; Olympus; IntroMedics (Korea); OMOM (China)

Double Balloon/Single Balloon Enteroscopy (Japan 2001)

Capsule Endoscopy

Current Capsule use: Small Bowel

Obscure GI bleeding Small Bowel Disorders

Tumors NSAID ulcers Celiac/Sprue Crohn’s Colitis

Esophageal Varicies Barrett’s Esophagus

Capsule Endoscopy – Small Bowel

Process: Prepares

bowel using standard colon prep

Sensor Array applied

Ingest Capsule

Capsule Endoscopy – Small Bowel

Download images

Wait 6-8 hours

EGD Capsule Placement

Capsule Endoscopy - Esophagus

Patients typically fast for two hours prior to undergoing the PillCam ESO procedure. Upon arriving the physician’s office, patients follow the Simplified Ingestion Procedure (SIP). While standing, a patient will first drink 100 mL of water. They will then be asked to lie on their right side, swallow the PillCam ESO video capsule and take one sip of water every thirty second for seven minutes. After seven minutes, the nurse will instruct the patient to sit upright, drink another sip of water and wait for thirty seconds. The PillCam passes naturally with a bowel movement usually within twenty-four hours.

Nursing Assessment/Education

Procedure Preparations

Standard Colon Preparation

½ Colon Preparation

Clear Liquids

Nursing Assessment/Education

Patient is able to meet time parameters (8 hour study). Patient has a valid consent. Patient is responsible to return equipment. Patient is able to understand and perform colon preparation. Patient is able to tolerate clear liquid diet. Patient does not have any swallowing disorders. (Review radiological studies). Patient does not have or suspected to have a gastrointestinal obstruction. (Review

radiological studies). Patient does not have or suspected to have strictures. Patient does not have or suspected to have fistulas. Patient does not have or suspected to have a Zenker's or Meckel's Diverticulum. Patient does not have a cardiac pacemaker or implanted electromedical devices. Patient does not have a history of or suspect slow gut transit time. Patient does not have an MRI scheduled within 1 week of capsule ingestion. Patient is not pregnant. LMP for women of child bearing ages. Patient requires EGD for capsule placement. Type of work. Check for possible electromagnetic issues. 

Agile Capsule

Nursing Assessment/Education

Once the capsule is ingested

1. Document the time the capsule was swallowed 2. You may start clear liquids 2 hours after swallowing the capsule. You may take your necessary medications at this time. **Nothing Red.3.You may have a light lunch (half sandwich/cup of soup, etc) 4 hours after swallowing the capsule.4. You should not be near any source of electromagnetic fields (MRI, Ham radio) or microwave oven. 5. NO strenuous physical activity, including bending over during the exam.6. You will need to check the blue light on the top of the data recorder every 15 minutes during the exam. The exam takes approximately 8 hours.7. DO NOT DISCONNECT the equipment during the exam.8. DO NOT enter federal or state buildings, airports, or banks with metal detectors while wearing the recorder. 9. Return to GI Clinic if you have nausea, vomiting or abdominal pain.

Streamlined Functionality – Function Bar

PillCam SB

Progress Indication available for full videos and only in A-mode

(not in M-mode nor for video segments)

Function bar

Streamlined Functionality – Tooltips

Place mouse cursor over any icon on the RAPID main

screen for Tooltip to display

Capsule Endoscopy

Capsule Endoscopy

Small Bowel Capsule Images:

Capsule Endoscopy

Esophageal Images:

FICE LITERATURE REVIEW

Computed Imaging Modification for Enhancement of Small-Bowel Surface Structures at Video Capsule Endoscopy

By emphasizing lesion hypervascularity and vascular morphology, FICE might aid in differentiation of neoplastic and non-neoplastic lesionsThis novel imaging technique has the potential to improve the diagnostic yield of video capsule endoscopy for obscure gastrointestinal bleeding

Endoscopy 2010;42(6):490-492.

Report Templates

Electronically Signed by:

Moti Frisch MD 01/06/2010

Referring physician’s reason for referral

Referring physician’s reason for referral

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Template

Localization

Progress Indicator

1 ON ON

2 ON OFF

3 OFF ON

4 OFF OFF

RAPID Real-Time v7.0

FEATURES

Key Feature Comment

Dedicated real-time only software

• No RAPID Reader

Lower pricing• Dell 2100 platform lowers costs while maintaining product quality

Functionality• Touch screen• Small size enables hand held use• Support for all PillCam video capsules

DELL 2100

Standard USB cable

DR 2

Capsule Endoscopy

Limitations: Diagnostic only Can’t control image view/direction Cannot inflate the bowel Limited field of view Still requires bowel prep Takes 6-8 hours May require EGD to pass capsule Capsule can be retained/cause bowel

obstruction

Smart Pill

Wireless Motility Capsule

Measures pH, pressure and temperature

Ingests the capsule after a meal.

Wears data receiver for up to 5 days

Excreted in stool after 24-48 hours

Smart Pill

Future of Capsule Endoscopy Colon Capsule Steering Drug Delivery Biopsy

Magnetically Guided Capsule Endoscopy

Swimming Capsules

Robotic Capsules

Drug Delivery Capsules