The PillCam goes on a fantastic voyage to help diagnose GI bleeding

October 9, 2019

Magdalena Espinoza, M.D. Internal Medicine - Digestive and Liver Diseases

A detailed close-up of a pill camera, showing the lens and internal components. — The PillCam, also known as capsule endoscopy, is a powerful diagnostic tool that patients swallow and it captures pictures of their small intestine.

For decades, sci-fi writers have fantasized about taking a “fantastic voyage” inside the human body. The story usually involves a maverick scientist getting miniaturized, popped into a syringe and then, next thing you know, he or she is slaloming around inside a live person.

Sounds outrageous, right?

Well, subtract the tiny scientist and you have the PillCam, one of the many advanced medical technologies UT Southwestern physicians use to better diagnose and treat patients. While it sounds futuristic, the PillCam has been around for two decades and UT Southwestern was the first medical institution in Dallas to acquire the technology.

Nowadays, our GI team uses PillCam SB3, the newest version of the technology. It is among the many leading-edge tools we use at UT Southwestern Frisco to better diagnose and care for our patients.

Let's take a closer at the PillCam and how it works, so the whole concept is a bit easier to, um, swallow.

: The PillCam is a plastic capsule about the size of a large vitamin or fish oil pill (26 mm). It’s equipped with a tiny camera and light inside so it can capture color close-ups of your digestive tract, specifically the small intestine. It also has an antenna to transmit images to a wireless recorder that patients wear on a specially designed sensor belt. The doctor syncs the recorder to the PillCam before you swallow it.

: The newest version of the PillCam shoots two to six frames per second, or more than 50,000 images on a 12-hour journey through your insides. Although it can take photos of the entire digestive tract, the PillCam’s primary use is detecting problems in the small bowel, an area that can be difficult to access with traditional endoscopy or colonoscopy. It’s particularly effective at detecting obscure bleeding, iron deficiency anemia, and lesions as small as 0.07 mm.

: About 10-12 hours before the procedure, patients begin drinking a liquid that will help cleanse the bowel – incidentally, that’s only about half the amount of liquid typically prescribed for a colonoscopy because the screening focus is on the small intestine. Patients will also have to limit themselves to a clear liquid diet before the procedure. Once in the doctor’s office, the patient will swallow the PillCam, which has a slippery coating, with a glass of water. After that, they can go about their day. The camera will be generating clear images of the small intestine and sending them to a data recorder for downloading and analysis later by your GI specialist.

: That may be the most-asked question by patients: ‘Do I need to retrieve the pill?’ In a word, no. Pictures are transmitted through radio frequency and then patients pass the PillCam naturally. It’s a one-use pill.

: It was originally developed 20 years ago for military purposes – the tiny camera was used to guide missiles. The Israeli manufacturer Given Imaging transitioned the technology to civilian health care use, and in 2001 it was approved by the U.S. Food and Drug Administration (FDA). UT Southwestern began using PillCam technology in 2005, for diagnosing inflammation and pre-cancerous or dilated veins in the esophagus. We were the first medical institution in Dallas to acquire the PillCam ESO technology. Nowadays, our GI team uses PillCam SB3, the newest version of the technology.

: There is a remote chance — less than 1% — the PillCam may get lodged in your digestive tract. The chance rises slightly for patients with known small bowel obstructions or with Crohn’s disease. In those cases, before using the PillCam we will typically have the patient swallow a sugar pill, and 12 hours later take an X-ray to see if it passes the colon. If it does, then we’ll move forward with the PillCam. Even in the rare cases when the pill does get stuck, clinical research has shown it doesn’t pose any serious health risks and can be removed by enteroscopy (a special form of endoscopy or colonoscopy). In very rare cases, patients may require surgery for removal.

: There are several reasons: first, the PillCam is a powerful diagnostic tool, but it can’t fix a problem it detects. Colonoscopy and endoscopy, which are more invasive and require anesthesia, are diagnostic and therapeutic. In those two procedures, gastroenterologists use a long flexible tube with a camera and light attached to it to screen for problems, such as precancerous polyps, and then remove them during the procedure so they can be biopsied.
Second, the colon is larger than the small intestine, which means the PillCam isn’t as effective at capturing the close-ups it can take in the small intestine. Colonoscopy and endoscopy are still the gold standard for diagnosing and addressing GI conditions.
Third, in 2014, the FDA approved PillCam COLON 2, a minimally invasive capsule designed to view the colon. But approval was limited ‘for use only in patients who had an incomplete optical colonoscopy.’ In clinical trials and several studies, standard colonoscopy was proven more effective in identifying polyps.

: While the PillCam isn’t necessarily new to the GI community, patients are still intrigued by what it can do. They think it’s like something out of ‘The Magic School Bus,’ (the classic PBS animated series where a beloved science teacher took her class on wondrous adventures, sometimes inside the human body). They also like that there is no anesthesia and less prep. It is fascinating technology, and it gives us a minimally invasive way to take a look and see what’s going on, particularly when an upper endoscopy or colonoscopy can’t provide a definitive answer.