Wireless Capsule Endoscopy. GI Unit Endoscopy Department Patient Information Leaflet
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1 Wireless Capsule Endoscopy GI Unit Endoscopy Department Patient Information Leaflet
2 What is a Wireless Capsule Endoscopy (WCE)? Wireless Capsule Endoscopy (WCE) allows specialists to see pictures of your small bowel. To do this, a disposable camera is miniaturised to fit into a capsule which can be easily swallowed. It is not much larger than most treatments swallowed in a capsule form. Once the capsule has been swallowed, it starts to transmit pictures of the lining of the bowel to a receiver strapped to the outside of your body. The capsule has its own light to allow the camera to see the bowel wall. The tiny batteries which power the capsule are safely enclosed within it so are not harmful and last no more than eight hours, which is usually enough time for the capsule to pass right through the small bowel (duodenum, jejunum and ileum) and into the large or lower bowel (colon). Small abnormalities can easily be seen by the capsule and transmitted by a wireless technique. Up to 65,000 pictures can be stored for later examination by a trained specialist on a special dedicated computer. Why have a Wireless Capsule Endoscopy (WCE)? You have been advised to have a test called Wireless Capsule Endoscopy (WCE) by your hospital consultant. You may have had many other tests already, often involving an endoscope. However, WCE does not involve a long black flexible camera such as those used to examine you during previous tests. It is a new way of looking at the inside of the small bowel, developed to be more comfortable for patients. 2
3 Is there an alternative to this test? The test is in addition to many other tests that you may have already had to discover the cause of your problems. There are other ways of looking at your small bowel, but none of these are as effective or as comfortable as WCE. X-ray procedures such as barium follow through, small bowel enemas and angiography are not always very effective. Long endoscopes can be passed into the small bowel (enteroscopy). This is often uncomfortable and unhelpful as only about a third of the small bowel can be seen this way. WCE has been shown to be effective at detecting small bowel problems which have not been diagnosed by other tests. What do I have to do? The day before your test: From 2pm the day before you must restrict your diet to liquids only and you should not eat any food. From 9pm the night before you must also stop drinking fluids. You are required to fast for 12 hours prior to your test. You will also have been sent a laxative treatment called Klean Prep. This will clear your bowel of food residues so that the capsule can obtain clear pictures. 3
4 Instructions for taking Klean Prep The day before your test: 2.00pm Clear fluids only after this time. Clear fluids include drinks such as water, squash (not blackcurrant as it can stain your bowel), black tea/coffee and clear soup. 4.00pm Fill a jug with 1 litre (1¾ pints) of water (not chilled). Empty the contents of one Klean Prep sachet into it and stir until the powder is completely dissolved and the solution goes clear. Drink one glass full of the solution from the jug about every 15 minutes until you have drunk it all. This should take about an hour. 5.00pm Make up the second sachet of Klean Prep and drink it over the next hour. Some patients say that they feel sick when taking Klean Prep. If you are affected by this: Try having a break then taking the Klean Prep solution in sips. Try drinking the Klean Prep solution through a straw. Add different flavours such as flavoured squash but please do not use blackcurrant squash as this can stain the bowel. Suck mint-flavoured sweets between drinks. If you get a headache drink lots of clear drinks and take paracetamol if necessary. 4
5 On the day of the test: Do not take any medication on the morning of the test. You will be able to take it after the procedure if necessary so please bring it with you. The test starts in the morning at around 8.30am and will finish at about 5.30pm. Please make sure you arrive at the GI Unit, 1 st Floor, West Wing, Russells Hall Hospital at 8.00am. Please wear loose two-piece clothing to allow easy access to your stomach area. Men may need to be shaved in a small area so that sensor discs can stick to the skin. Bring a book, newspaper or music to occupy yourself during the test as you will be with us all day. What happens before the test? You will be welcomed by one of the nurses and settled onto a trolley in the GI Unit recovery area. You will be asked a few questions and to sign your consent form. The nurse will then place sticky patches (sensor discs) over your stomach to monitor the capsule. When the capsule has been switched on you will be asked to swallow it with a glass of water. You will be asked to lie down on you right side until the capsule has moved through the stomach and into your small bowel. We may be able to show that this has happened using a special real time scanner and you will be able to see actual pictures of the lining of your bowel. 5
6 You then will be able to sit up in a chair and after two hours you will be offered a drink. After four hours you will then be able to have a light meal which we will provide if you wish. You will also be given drinks throughout the rest of your stay. After eight hours (around 5.30pm) the test will be completed and the equipment (such as sensor discs) will be removed before you go home. You can drive, eat and drink normally at this point. You should feel no pain during the test unless the capsule detects narrowing of the bowel. What happens after the test is over? You can go home and eat and drink normally. You may notice the capsule passing out of your body in your motions or into your stoma bag if you have one. The capsule is disposable. If you have not passed the capsule after three weeks, it may be necessary to take an X-ray of your stomach area. The risk of this happening is very small (it happens in up to two per cent of patients with bleeding from the bowel and in up to five per cent of patients who have Crohn s Disease). If the capsule cannot pass freely through your bowel it is not dangerous. However, this may indicate that you have a narrowing (stricture) of the small bowel. You may need surgery to identify and treat this. You will be informed of the result as soon as possible but it may take some time for the recording to be analysed on the computer. Once your results are available you will seen by your consultant in an outpatient appointment. This appointment will be sent to you in the post. 6
7 What does the capsule detect? Any problem in your stomach or small bowel which can cause bleeding into your bowel can be seen. Sources of bleeding, inflammation (for example in diseases like Crohn s), small areas of abnormal blood vessels (angioectasia), small tumours (not necessarily cancers), coeliac disease, ulceration and narrowing are just some of the findings we look for to explain your symptoms. These problems are usually very difficult to detect by other tests. Is there any other information needed by your doctor? Pacemakers / defibrillators will not prevent you from having the test but it is important you let us know if you have one as we will perform a brief ECG test to ensure there are no problems before you swallow the capsule. You should not undergo an MRI Scan until the capsule has definitely passed out of your body. If you have difficulty swallowing please let us know. Under certain circumstances we may have to help you swallow the capsule under sedation (with a gastroscope) but this unusual. If you are a diabetic please contact the department before the test. Aftercare When the procedure has been completed you will be given an aftercare information leaflet before you leave the department. 7
8 Consent You will need to give consent before the doctor or health professional examines or treats you. As part of your treatment some kind of photographic record may be made for example; clinical photographs, video recordings or an X -ray. You will be told if this is likely to happen. The photograph or recordings will be kept with your notes and will be held in confidence as part of your medical records. This means that it will normally be seen only by those involved in providing you with care or those who need to check the quality of care you have received. The use of photographs is extremely important for other NHS work such as teaching or medical research. However, we will not use yours in a way that allows your identity to be recognised without your permission. You will be asked to sign a consent form once the procedure has been discussed with you. Health professionals must ensure that you know enough about the procedure beforehand, and that you are fully aware of the benefits and risks of the procedure. Once the consent form is completed you will be given a copy to keep. If you later change your mind, you can withdraw your consent after signing. 8
9 Can I find out more? The NHS Choices website has information about endoscopy procedures including WCE: If you have any questions or if there is anything you do not understand about this leaflet please contact: The GI Unit on (01384)
10 Originator: L Edwards Date originated: February 2014 Date for review: February 2017 Version: 3 DGH ref: DGOH/PIL/
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