1. Wireless video capsule endoscopy
( WVCE):
Dr.Mohamed Al-Shekhani

2. Definition:
• Visualization of the GI tract by transmitting images
wirelessly from a disposable capsule to a data recorder
worn by the patient.
2

3. History:
• The first model for the small intestine
approved by FDA in 2001.
• Over subsequent years, VCE developed
with superior resolution, increased
battery life& capabilities view different
parts of the GI tract.
3

5. Companies producing WVCE:
•
•
•
•
•
5
3 companies that manufacture smallbowel WCE systems approved by FDA:
PillCam SB2, Given Imaging, Ltd, Israel;
Endocapsule, Olympus America, Inc,
Center Valley, Pennsylvania;
MiroCam, IntroMedic Company Ltd,
Seoul, Korea
Capsules for esophageal imaging /colon
imaging also are available from Given
Imaging.

6. 6

7. Components:
WCE system: 3 components:
(1) Capsule endoscope with a
light source, camera & battery.
(2) A sensing system with sensing
pads or a sensing belt to
attach to the patient, a data
Recorder, a battery pack
(3) A personal computer with
proprietary software.
+ handheld viewers allow realtime review of images during
WCE examinations
7
Battery life
 8-12 hours.

9. SI Imagings:
OP;Fasting or clear liquids for 10 -24 hs.
A full or partial bowel prep improve
visualization.
Capsule is activated by removal from a
magnetic holder.
After ingestion, patients are instructed to
keep a diary of symptoms and monitor
the lights on the data recorder to confirm
that the signal is being received.
Avoid exercise that may cause the
sensors to detach.
9

10. SI imaging:
A diet of clear liquids is allowed after 2
hours& a light meal after 4 hours.
The reusable data-recording system can
be disconnected from the patient after
the lifespan of the battery has expired.
The capsule is disposable& designed to
be excreted.
The data recorder is subsequently
connected to a workstation for transfer
of the acquired images.
10

12. Esophageal VCE:
• Fasting for 2 hours.
• the patient drinks 100 mL of water while
standing ,ingests the activated capsule in
supine position with a 10-mL sip of water.
• A 2-minute recording with the patient
supine, 2 minutes raised to 30 , additional
minute at 60 , followed by an upright
position for 15 minutes to maximize time
for the capsule to capture images as it
traverses the esophagus.
12

13. Colon VCE:
•
Not approved in US but approved in
Europe.
• Sensitivity less than colonoscopy.
13

15. Agile patency system:
• A radiopaque non-video, dissolvable
capsule .
• For those with high risk for retention.
• Delivery devices: for those who can not
swallow the capsule.
15

22. Indications:
• (1) (OGIB), overt & occult, including IDA
• (2) Suspected Crohn’ s Disease
• (3) Surveillance in polyposis syndromes.
• (4) Suspected small-intestine tumors
• (5) Suspected or refractory malabsorptive
syndromes (eg, celiac disease).
• FDA approved VCE for the esophagus
evaluation for suspected Barrett’ s
esophagus, esophagitis, or esophageal
varices.
22

23. Contraindications:
• Relative :
• (1) Known or suspected GI obstruction,
strictures, or fistulas based on the clinical
picture or preprocedure testing
• (2) Cardiac pacemakers or other
implanted electromedical devices
• (3) Swallowing disorders
• (4) Pregnant.
23

24. Interpreter:
• ASGE guidelines:readers should have
either undergone formal capsule training
during fellowship or have completed a
formal GI or surgical society– endorsed
training course with proctoring of the
first 10 capsule readings.
• The average reading time 30-120 mins,
dependant on SI transit time&experience.
• For VCE esophagus, the average reading
time 5-15 minutes.
24

25. OGIB: Detection rate
35-77% dependent on various factor:
Earlier WCE (within 1 wk of bleeding),
Inpatient status
Overt tranfusion – requir GI bleeding
Male sex.
Increasing age.
Use of warfarin
Liver co-morbidity
25

26. Indications:
Benefits: OGIB
Impacts on patient
management (surgery,
medical therapy,
NSAIDs withdrawal).
Better than barium/most
imaging studies
With the exception of
therapeutic potentional
both VCE & DBE have
comparable results.
26
•.
CD:
Valuable adjunctive
diagnostic test after
conventional
endoscopy&
colonoscopy with
ileoscopy.
Calculate activity score.

27. ...
SI tumors:
Feasible/safe in known or
suspected polyposis
syndromes as FAP or PJS.
WCE was effective
in detecting additional polyps
in the jejunum
May not be able to adequately
visualize the ampulla of Vater.
Better than Barium and MRI
eneterography sp for small
polyps.
27
SI tumors:
WCE may have a role
in the evaluation of smallbowel tumors, but a
negative exam
should not preclude
further work-up if a lesion
is highly suspected.

28. ...
CELIAC DISEASE:
Possible advantage
over endoscopy in “
patchy” disease.
An additional role of WCE
specifically in
complicated
celiac
disease(ulcer,stricture,
tumor).
28
Eso diseases
WCE is inferior to OGD
for the diagnosis of
esophagitis&Barrett’.
WCE is inferior to
endoscopy
for the
diagnosis/grading of EV
for screening.
? MAGNET.

36. Safety
Generally safe: only concern is retention;1.3%
Retention
.Remaining
for 2 wks or
required
directed
therapy.
36
Risk
strictur:e: CD,
SI tumors,
radiation,NSA
ID,Surgical.
Zenker div,
duodenal div,
umbil hernia,
Meckel).
Diagnosis/trt
Abd imaging
after 2 weeks
if retention is
suspected&if
confirmed,
surgery or
endoscopic
intervention.
perforations
• 2 cases in
CD.
• Tracheal
aspiration
.

37. Interference with cardiac devices:
Generally safe, but not used until more
data available.
MRI should not be done until the VCE
passed.
37

38. Summary:
A valuable test for imaging the SI.
It is a safe &easy to perform that can provide
valuable information in the diagnosis of SI
conditions.
Its applications still remain limited within the
esophagus& colon.
Future developments: improving visualization
of esophagus &improved manipulation of
the capsule within the GI tract & biopsy
capabilities.
38