Friday, July 30, 2010

Limitation of capsule endoscopy

What are the limitations of capsule endoscopy?

While the capsule provides the best means of viewing the inside of the small intestine, there are many inherent limitations and problems with its use, the most important of which is that the capsule does not allow for therapy. Other problems include:
  1. Abnormalities in some areas of the intestine are missed because of rapid transit of the capsule and blurred, uninterpretable photographs.

  2. At times, transit is so slow that the capsule examines only part of the small intestine before the battery fails.

  3. If abnormalities are discovered that require surgical resection or further investigation, it may be difficult to determine where in the small intestine the abnormality is and thereby help direct therapy.

  4. If there are narrow areas due to scarring (strictures) or tumors in the small intestine, the capsule can get stuck in the narrow area and cause an obstruction of the intestine that requires surgical removal of the capsule. (For this reason, in patients who are suspected of having a stricture, a self-dissolving, dummy capsule is swallowed first. If the dummy capsule sticks, it can be seen on an x-ray of the abdomen and the location of the stricture determined. Because it dissolves with time, however, the obstruction will resolve without surgery, and the real capsule will not be swallowed.)

  5. Finally, reviewing the tens of thousands of photographs is very time consuming for the conscientious physician.

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