Swallowable cameras the size of large vitamin pills are helping physicians diagnose problems in parts of the gastrointestinal tract that they previously had difficulty analyzing.


The technology is called capsule endoscopy and involves a camera that takes photographs of the digestive tract as the capsule traverses through a patients body.


Capsule endoscopy has become the gold standard for diagnosis of Crohns Disease and also will become the gold standard for small-bowel bleeding and other problems, says Bob Westlake, a physicians assistant who practices with Spokane gastroenterologist Dr. Klaus Gottlieb, who is using the technology.


In addition to small-bowel bleeding and Crohns Disease, which is an inflammatory bowel disorder, capsule endoscopy can be used to help diagnose small-bowel injuries caused by drugs, benign and malignant tumors, and polyps.


With capsule endoscopy, sensors are placed on a patients abdomen then are connected to a data recorder on a belt that is strapped around a patients waist. Once the patient swallows the camera, it continually transmits images from inside the patients body to the data recorder at a rate of two per second, creating a nearly seamless series of pictures. The capsule includes a low-power flash that illuminates the immediate vicinity each time the camera takes a picture.


Once the capsule reaches the stomach, it spends about an hour there before entering the small intestine, then will spend two or three hours in that small bowel, Westlake says. The disposable camera then proceeds through the large intestine and leaves the body during a bowel movement.


Westlake says patients are encouraged to do routine daily activities, such as going for walks or running errands, while the capsule is working its way through their gastrointestinal system.


Gottlieb says that conventionally, physicians have been able to view the large bowel, or intestine, via a colonoscopy, and the upper part of the digestive tractincluding the esophagus, stomach, and first 10 inches of the small bowelthrough a conventional endoscopy. A colonoscopy is performed with a flexible-rod probe equipped with a camera. The probe is inserted into the body rectally.


A conventional endoscopy of the esophagus, stomach, and small bowel involves a similar type of probe that is inserted orally.


Neither a colonoscopy nor a conventional endoscopy, however, is able to view the 20 feet to 25 feet of small bowel in the middle.


Other than capsule endoscopy, methods of screening the small bowel are limited, Gottlieb says.


A small-bowel endoscopy can be performed, but the procedure is very painful and incomplete, he says. An X-ray of the small bowel can be taken, but small defects often are obscured by the various folds of the intestines.


Capsule endoscopy, however, has its drawbacks as well, Gottlieb says. The capsule cant be guided and usually tumbles through the digestive tract. In many cases, the capsule will take a number of pictures of the same spot before moving forward.


Westlake says, however, that the images are downloaded to a computer, and a capsule-endoscopy software program reviews them and highlights any inconsistencies.


Westlake says he reviews all images, paying particular attention to the highlighted ones, and that repetitive images are easy to fast-forward through.


Gottlieb says Medicare has approved capsule endoscopy as a first-line investigation of inflammatory bowel disease and chronic blood loss in the bowel.


Its likely more and more applications will be approved for capsule endoscopy, he says.


Problems diagnosed with capsule endoscopy typically are followed up either with medications or some sort of surgery, Westlake says.


The U.S. Food and Drug Administration approved use of capsule endoscopy in 2001. Gottlieb began using capsule-endoscopy technology last fall and has performed 11 such procedures so far.


He says at least one other Spokane practice also has capsule-endoscopy capabilities.