capsule experience - MG Lorenzatto

16
Chapter 2
Typical timing of a capsule exam is to have a patient swallow
the capsule at 8 am and disconnect them from the recorder
at 4 pm. This allows 8 hours of acquisition of images during
the day. Capsule endoscopy is performed after the patient
follows a 12 hour fast. Patients are told to have nothing to
eat or drink after dinner on the evening before the examination.
Patients should not smoke cigarettes, since this may cause
a change in the color of the stomach lining. They are also
told not to take medications or antacids. Medications such
as iron and sucralfate can coat the intestinal lining limiting
visualization. Narcotics and antispasmodics can delay both
gastric and intestinal emptying making it difficult to visualize
the entire small bowel during the 8-hour acquisition time.
Patients are told to bring their medications with them to take
accordingly during the day if necessary. If a patient is diabetic,
insulin doses need to be adjusted. Patients are also told to
wear loose clothing on the day of the exam. Dresses should
be avoided. A buttoned shirt and loose fitting pants work
best. During the evening prior to the exam, the recorder's
battery pack is trickle charged through a standard outlet.
Initially on the day of the exam, the patient's personal data
is entered into the computer workstation (Figure 1). The
recording device is then initialized to the patient. This ensures
that once completed the recording device and the data
contained within cannot be confused with any other patient.
At this point, patients may be asked to drink a small glass of
water containing simethicone. This surfactant eliminates any
bubbles inside the
stomach.
The patient's abdomen is
marked with a surgical
marker using a template
for accurate placement
of sensors.
The Performance of Capsule Endoscopy
The markings are best removed at the end of the exam using
rubbing alcohol. The sensor array leads are attached by
adhesive to the patient's abdomen. Some patients may need
to shave their abdomen prior to sensor attachment.
The empty belt is placed around the patient's waist.
The recording device and battery pack are then placed into
the belt pouches. The sensor leads are attached to the
recording device which is then attached to the battery pack.
The powered recorder will illuminate its light for a short period
of time. This light will go out once the hard drive has
successfully booted. The capsule is then removed from its
blister pack. Removing the capsule from the magnet in the
pack turns the capsule on and it begins to flash twice per
second and transmit images. It is important to look at the
recorder and ascertain that its light flashes in synchrony with
the capsule verifying successful transmission.
The patient then
swallows the capsule
followed by a full glass of
water. We ask patients
to drink two additional
glasses of water to assure
that the capsule
impasses through the esophagus into the stomach. The
patient is then told that she/he can leave the facility and carry
about a normal day. Patients are told to refrain from exercising
and heavy lifting during the exam. They should avoid large
transmitters and MRI machines. They may walk, sit and lay
down. They can drive a car. They can return to work. They
may use a computer, radio, stereo or cell phone. They should
not stand directly next to another patient undergoing capsule
endoscopy. They should not touch the recorder or the antenna
array leads, nor should they remove the leads.