Most digestive disease specialists will tell you that patients would rather suffer from heartburn and other diseases of the upper GI system than undergo a very effective but also potentially uncomfortable and relatively invasive procedure to diagnose their problem.
Today, though, these patients in the Digestive Disease Institute at Thomas Jefferson University Hospital, Philadelphia, can benefit from a new device - a camera in the shape and size of a vitamin capsule - that can be swallowed with water while the patient is in the physician's office.
Known as the PillCam ESO, the device follows on an earlier version which is now very popular as a way to diagnose unexplained gastrointestinal bleeding and other gastrointestinal disorders. With this version, the patient lies on her or his back and ingests the camera pill. There is no anesthesia necessary.
"This new PillCam allows us to offer an accurate non-invasive test," says gastroenterologist Anthony Infantolino, M.D., clinical assistant professor of Medicine at Jefferson Medical College of Thomas Jefferson University. "And because there is no anesthesia required, patients can obtain this test while on their lunch hour; they don't have to take a day off from work as they would with an endoscopy, the traditional diagnostic screening."
When undergoing an endoscopy procedure, patients cannot eat or drink anything for at least eight hours beforehand. Also, since they will be sedated, patients are asked to arrange for someone to take them home.
The endoscopy procedure involves the swallowing of an endoscope--a long, thin and flexible, lighted tube. The endoscope transmits an image of the inside of the esophagus, stomach and duodenum, so the physician can carefully examine the lining of these organs. The scope also blows air into the stomach; this expands the folds of tissue and makes it easier for the physician to examine the stomach. The physician can also insert instruments into the scope to remove samples of tissue for further tests.
Although the entire procedure takes 20 to 30 minutes, patients are asked to remain in the physician's office until the sedation wears off, often two or three hours. They cannot work or drive for approximately 24 hours. The PillCam offers an easy alternative.
Once swallowed with a few sips of water, the camera glides down the esophageal tract taking about 2,600 color pictures (14 per second), which are instantly transmitted to a recording device worn by the patient.
After 20 minutes, the doctor has enough video images to make an immediate diagnosis. There is no recovery time necessary for the patient, the doctor takes no tissue samples and the disposable capsule is passed naturally, usually within 24 to 72 hours.
Doctors at Thomas Jefferson University Hospital are among the first in the area, and among a select group nationally, to use this newly approved device to diagnose diseases of the esophagus.
"The Pillcam is the ideal diagnostic device to check for Barrett's Esophagus (which comes from chronic acid reflux), a condition that increases the risk of developing esophageal cancer, one of the fastest growing types of gastrointestinal cancers in the United States," explains Dr. Infantolino, who is also co-director of the Capsule Endoscopy Program in the division of Gatroenterology and Hepatology at Thomas Jefferson University Hospital. "Today, we recommend that anyone who has chronic acid reflux two or three times a week for more than five years, be screened to ensure that there is no problem."
Patients who will be diagnosed as a result of the Pillcam should not eat for two hours prior to the procedure. Dr. Infantolino cautions that the new device is not suitable for those with swallowing disorders, pacemakers or with known or suspected gastrointestinal obstruction, strictures or fistulas.