Visionary science for the intestine

From Chicago, Ill., at a meeting of the Radiological Society of North America

Compared with other parts of the digestive tract, the small intestine is difficult for doctors to access. While a camera-tipped tube slipped down the throat can get images of the stomach and a tube inserted at the other end of the tract reveals the large intestine, no such device reaches into most of the small intestine. So, physicians rely on externally generated images.

Scientists recently devised a disposable flash camera only slightly larger than a vitamin pill. In a procedure called capsule endoscopy, the patient swallows the minicam, which then takes pictures inside the small intestine. On its journey through the digestive tract, the tiny tumbling camera transmits images that are stored in a recorder that the person wears around the waist. After 8 hours, the camera’s battery runs out, and the capsule is eliminated in the feces. Scientists then download the recorder’s images into a computer.

To test the value of capsule endoscopy, researchers recruited 42 people who had had either an X ray after drinking a barium solution or a computerized-tomography (CT) scan to image the condition of the small intestine. Each person then underwent capsule endoscopy.

The minicam missed a few abnormalities but detected nine intestinal ulcers, compared with only three found by the CT scan and one by the X ray, says Amy K. Hara of the Mayo Clinic in Scottsdale, Ariz. The capsule camera also revealed 11 cases of an intestinal condition, called arterial-venous malformation, in which blood vessels in the intestines leak. Neither the X ray nor the CT detected any.

“Compared with these other techniques, the capsule is a major step forward,” Hara says. “It’s noninvasive, doesn’t require any medications or radiation, and, we now know from our study, it results in better and more complete evaluations of the small intestine.”

Capsule endoscopy is, however, more expensive than the other procedures. Nevertheless, combined with CT scans and X rays, capsule endoscopy could vastly improve diagnosis of small intestinal ailments such as Crohn’s disease, inflammatory bowel syndrome, and arterial-venous malformation, Hara says.


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