Small Bowel Capsule Endoscopy
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You have been advised to have a small bowel capsule endoscopy.
This procedure requires your formal consent. This booklet has been written to enable you to make an informed decision about whether or not you would like to have a capsule endoscopy. You will be required to sign a consent form on the day of the procedure to say that you are happy for it to go ahead, therefore please read this carefully.
If you are unable to keep your appointment, please notify the Endoscopy Unit as soon as possible. This will mean we are able to offer your appointment slot to someone else and we will rearrange another date and time for you to attend a new appointment.
You need to understand all the information, including the possibility of complications. There will be the opportunity to speak to a healthcare professional about anything that you do not understand on the day of the procedure before you sign the consent form.
What is a capsule endoscopy?
A capsule endoscopy (pillcam) is a test that involves swallowing a capsule which looks for abnormalities in the small bowel. The small bowel (intestine) is the part of the gastrointestinal tract between the stomach and large bowel (colon). The bowel is small in diameter but is between three and five metres long.
Why am I having a capsule endoscopy?
A pillcam is used when a conventional endoscopy (colonoscopy or gastroscopy) has failed to reveal a cause for unexplained anaemia (iron deficient anaemia) or intestinal bleeding. In this situation, a pillcam will find an answer in about 70% of cases. Another common reason to use the pillcam is to diagnose Crohn’s disease, particularly in cases where the diagnosis is suspected but not confirmed using standing endoscopy tests and x-rays. In this situation, we find evidence of Crohn’s disease in about a third of the patients investigated.
In some patients, the reason for using the capsule is surveillance of coeliac disease and hereditary polyposis syndromes.
How is the test done?
The capsule is the size of a large vitamin pill. It contains a tiny video camera on a silicon chip. You will be asked to swallow the capsule after taking laxatives and fasting for 10-12 hours. The capsule starts taking the photographs which are sent by transmitter through to sensors. The sensors are in a belt worm around your waist.
From there, the images go to a data recorder (pocket size computer) which is carried around in a shoulder bag. The whole process takes 8-10 hours and the capsule is usually given in the morning. About 20 minutes after swallowing the pillcam, we will check if it has left the stomach. Some people have slow gastric emptying. If this is unsuccessful, it may be necessary to place the capsule using an endoscope. This will only be done if it is essential, and after discussion with you first.
After checking the capsule’s position, you can either go out for the day with instructions or stay on the Endoscopy Unit. The equipment is removed after 8-10 hours. The images are then downloaded from the data recorder to a computer which puts the images into a video. The video can then be reviewed by the doctor or nurse.
How do I prepare?
To get a clear view of the colon it is important that the bowel is empty of faeces. You will be sent information on how to do this. You will be given detailed instructions about stopping certain medication such as iron tablets and constipating agents.
You will be given details on what to eat before the procedure and you will be given a laxative solution to clear your bowels. Your referring doctor will have indicated if you are able to take the bowel preparation, please contact us if you are unsure.
Please note: we advise that you read the patient information leaflet enclosed in the Moviprep packet as well as reading this information. Please follow the preparation instructions outlined here for the test, not the Moviprep leaflet.
It is important that you make sure that you are not allergic to any of the Moviprep ingredients and that it does not react with any other medication you are taking. If you experience common side effects such as vomiting, bloating and stomach cramps, try drinking the Moviprep more slowly. If you experience other side effects or have any questions regarding the Moviprep, please contact the Endoscopy Unit: 01908 996 463.
Two days before the examination, you should start a low fibre diet:
| Food allowed | Food forbidden |
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The day before the examination have a light breakfast (before 9:00am) i.e. white toast. Following this you must not take any further solid food, only clear fluids.
| Clear fluids allowed*: | Clear foods forbidden: |
*preferably without sugar |
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Following the instruction, dissolve the first sachet of powder into one litre of water and drink this over the next 1-2 hours starting at 5:00pm. Repeat the same instructions for the remaining sachet at 8:00pm. It is important to drink an additional 500ml of water after each litre of Moviprep. You may mix your sachets with lime cordial. Loose bowel movements may occur any time after the first sachet until you have taken both. Please only drink water from 9:00pm the night before your procedure.
Please note: Moviprep will cause watery, diarrhoea-like bowel movements, so stay near a toilet.
What about my medication?
Please continue taking your prescribed medications. If you are taking iron tablets or supplements, stop taking these seven days before your appointment. If you are taking any painkillers that contain Codeine, Tramadol, Co-Proxamol or Morphine you should not take these for seven days before your appointment. Paracetamol based pain relief may be substituted. Your GP will be able to suggest alternatives if you are having difficulty. Bring your tablets or medications with you so that you can take them after you have had your procedure. If you are diabetic or require further advice about your medication, please ring the Endoscopy Unit.
If you are taking the oral contraceptive pill, you should take it at least three hours before taking the bowel cleansing preparation and then continue taking the pill as normal from the next day. Alternative contraceptive precautions should be taken for the rest of your cycle. If you have further questions or concerns please contact your GP or practice nurse for clarification. Do not take any medication two hours before having the examination.
What to bring with you
Along with your appointment letter you will have received a health questionnaire, please complete this and bring it with you. Read it carefully before your appointment but please do not sign it until the day of your procedure. Please wear loose-fitting, two-piece clothing for east attachment of the belt. Do not wear lipstick, lip gloss or other treatments on your lips.
What happens when I arrive?
After checking in at reception, a qualified nurse will welcome you and take you to the admissions area where you will have a brief medical assessment. In the admission room, you will be asked some questions regarding your medical and surgical history to confirm that you are fit to undergo the procedure. The nurse will make sure that you understand the procedure and will discuss any questions you may have.
Your blood pressure, heart rate, respiration and oxygen levels will be recorded. If you have diabetes, your blood sugar level will also be checked and recorded. All your belongings will be kept with you throughout your procedure to prevent anything being lost.
Small Bowel Capsule Endoscopy
The Clinician will escort you to a private room where you will discuss what is going to happen, any risks and any side effects. You will be given the opportunity to ask any questions before you sign the consent form. This will be done before you are asked to swallow the capsule. A copy of the consent form will be offered to you. Further information about consent is available on the NHS Choices website.
A sensor belt which is connected to the recorder box will be attached to you. You will then be asked to swallow the capsule. Following this, you will be asked to stay in the Endoscopy Unit until the capsule has moved into the small bowel (it will be checked regularly, by the clinician, on the recorder box that is attached to you). After this, you will be given a capsule endoscopy event form and you will be allowed to go home and asked to return to the unit at around 5pm.
After swallowing the Pillcam
You may drink colourless liquids starting two hours after swallowing the capsule. You may have a light snack four hours after ingestion. After the examination is completed, you may return to your normal diet. Treat the PillCam recorder carefully. Avoid sudden movements and do not knock it against anything. Do not remove or disconnect the equipment at any time during the procedure, exceptions will be discussed with you. Avoid direct sunlight and be sure the sensor belt is tight at the waist, do not attach anything to it.
Check the blue flashing PillCam recorder every 30 minutes to be sure it is blinking twice per second. If it stops blinking or changes colour, note the time and contact the unit. Use the supplied capsule endoscopy event form, to note the time of any event such as eating, drinking, opening bowel or a change in your activity. Return the completed form to your Clinician when you return the equipment.
Avoid strong electromagnetic fields such as MRI devices or Ham radios after swallowing the capsule. Return to the Endoscopy Unit at the scheduled time to have the equipment removed. If you suffer any abdominal pain, nausea or vomiting during the procedure, contact the Endoscopy Unit.
If you have any problems when you go home, or are feeling worse than you expected, please contact the Endoscopy Unit on: 01908 996 463
Milton Keynes University Hospital is a teaching hospital and there may be a student and/or a trainee in the room or a supervised trainee may be doing your procedure. If you have any concerns or objections, please contact the Endoscopy Unit prior to your test.
What happens after the test?
After the equipment has been removed and the information has been downloaded, you may go home. The pictures will be looked at by a specialist nurse or doctor and a report will be sent to your Consultant, this may take 2-4 weeks. The capsules are disposable and it will be excreted naturally in a bowel movement. You do not need to return the capsule; it can be flushed down the toilet. You should be ready to get back to your normal activities immediately.
When will I know the results?
Results can take up to 2-4 weeks. This is because of the time it takes to look at the large number of images. Over 50,000 pictures need to be looked at, and this can take some time, especially as an abnormality may be present on only one or two images. Results are sent to your referring doctor and GP. If results are required urgently your doctor can contact us.
Are there any complications or risks?
Capsule Endoscopy is generally a safe procedure. The only real risk of capsule endoscopy is the failure of the Pillcam to pass through the small bowel. This has only happened approximately to one person in over 200 procedures.
Experience elsewhere suggests that when this happens, it does not pass through because of a narrowing in the small bowel which is the cause of the problem being investigated. So non-passage of the Pillcam does mean that the answer has been found. If this happens – the narrowing or obstruction in the small bowel may require surgery and the capsule would be removed at the same time. The capsule can stay in your body for years causing you no harm.
If there is any concern that you may have a narrowed bowel we would first perform a patency capsule examination. This is a dummy pill that is swallowed to check the small bowel is clear and therefore safe to swallow the pill camera. If you require a patency capsule further information will be given to you.
A retained capsule in the stomach is very rare and the capsule might need to be removed via gastroscopy in the Endoscopy Unit. Healthy gut retention is zero percent and bleeding from small bowel lesion is less than 1.5%. The result of unknown Crohn’s disease is less than 5%.
If the capsule remains in your stomach two hours after swallowing an anti-sickness injection would be given as this works by removing all the contents of the stomach into the small bowel. There is a very small chance of equipment failure which means the test would have to be repeated. MRI scanning is not permitted until the Pillcam has been excreted from the body.
Please tell us if you are pregnant as the capsule endoscopy should not be performed during pregnancy. If you have a cardiac pacemaker or internal electro-medical device please let us know by contacting the unit on: 01908 996 460.
Instructions for patients with diabetes
- Treatment by diet alone: If you control your diabetes by diet alone, you simply need to follow the instructions given to you to prepare for your small bowel capsule endoscopy.
- Treatment by tablets and/or insulin: You should inform the Endoscopy admissions office about your diabetes so that they can arrange for an early morning procedure time.
- Preparation on the first day: As advised in the bowel preparation instructions, there are two days of preparation before the procedure. When following the diet from the ‘allowed foods’ list on the first day, try to make sure you eat your usual amounts of carbohydrate from the allowed list e.g. white bread, white rice and white pasta. Continue to take your usual tablets and/or insulin and check your blood sugar levels as usual.
- Adjusting your diabetes medication to prevent hypoglycaemia (low blood sugar level): You will need to adjust your treatment the evening before and the morning of your procedure to reduce the risk of hypoglycaemia. As a result your blood sugar control may be a little higher than usual. This is only temporary in order to maintain your blood sugars throughout the procedure and you should be back to your usual level of control within 24-28 hours after the procedure. If you have any questions or concerns about adjusting your dosage, please contact your Diabetes Specialist Nurse well in advance for further advice.
- Carrying Glucose Monitoring: If you usually test your blood sugar levels, check them as usual on the morning of the procedure and carry your equipment with you to the appointment. If you do not usually check your blood sugar levels, please do not worry, they will be checked when you arrive for your appointment.
- People on tablets for diabetes: The day before the small bowel capsule endoscopy – clear fluids only after 9:00am. Aim to replace your usual carbohydrate intake from the list of permitted clear fluids. You may have sugary fluids or clear fruit juice to replace your usual carbohydrates.
| Metformin | Gliclazide | Pioglitazone | Sitagliptin/Saxagliptin/Linagliptin | |
| 48 hours before procedure | Continue tablets | Continue tablets | Continue tablets | Continue tablets |
| 24 hours before procedure | Continue tablets | Continue tablets | Continue tablets | Continue tablets |
| Evening before the test | Omit dose | Omit dose | Continue tablets | Continue tablets |
| Morning of the test | Omit dose | Omit dose | Omit dose | Omit dose |
| When discharged | Continue tablets | Continue tablets | Continue tablets | Continue tablets |
- If on glibenclamide/chlorpropamide or tolbutamide, change to gliclazide by obtaining a prescription from the GP. Test blood glucose 4-6 hourly. Treat ‘hypos’ with a glass of Lucozade (125 ml); no Carbohydrates.
People on insulin for diabetes
- The day before the small bowel capsule endoscopy: clear fluids only after 9:00am. Aim to replace your usual carbohydrate intake from the list of permitted clear fluids. You may have sugary fluids or fruit juice to replace your usual carbohydrates.
| Insulin once a day, morning | Insulin once a day, evening | Insulin twice a day | Insulin three times a day | Insulin four times a day | |
| 48 hours before procedure | Normal dose | Normal dose | Normal dose | Normal dose | Normal dose |
| 24 hours before procedure | Half the usual dose of insulin | NA | Normal morning dose | Normal morning dose, half lunchtime dose | Normal morning dose, half the lunch time dose with light lunch at 11:00 (e.g. smooth tomato soup, fruit juices – no pulp) |
| Night before test (evening meal replaced with a glass of Lucozade) | NA | Half the usual dose | Half of the evening dose | Half night-time dose | Half the evening dose. Give 75% of long acting insulin (Levemir/Determir or Glargine/Lantus) |
| Morning of the procedure (needs to be on AM list) | Omit insulin | NA | Omit morning insulin | Omit morning insulin | Omit morning insulin |
| Exenatide | Liraglutide | Exenatide LAR | |
| 48 hours before procedure | Continue | Continue | Once weekly injection – no change, take as usual |
| 28 hours before procedure | Continue | Continue | |
| Night before procedure | Omit | Omit | |
| Morning of procedure | Omit | Omit |
People are unique and the alternatives, risks and benefits will vary from person to person. We hope this information will support what you have already received from your doctor in enabling you to make an informed decision about your care. If you have any further questions, please ask.
Frequently asked questions
- If my symptoms have stopped before the capsule endoscopy, should I still come for the test?
Yes. It is important that you still come for the test. Your doctor has arranged the test to try and identify a cause for your anaemia or bleeding. - Will it hurt?
No. These examinations are not painful. - Can I drive home after the procedure if I choose?
Yes. There are no after effects from the test. - Can I park at the hospital?
Yes, we have four patient and visitor car parks on site. The nearest car park to the unit is car park B. - Can I get public transport to the hospital?
Yes, the hospital is well served by public transport. - Are there facilities to obtain refreshments?
Yes refreshments are available in the Eaglestone Restaurant or the main entrance. Tea and coffee are also available on the Unit.