Transcript Capsule Endoscopy

CAPSULE ENDOSCOPY
Kendall Yoshisato, RN, CGRN
Northern CA SGNA
September 22, 2012
OBJECTIVES
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Understand the history of small bowel
exploration
Review the indications for capsule studies
Discuss the nursing assessment/education
for capsule endoscope
Describe the role of the nurse reviewer
Capsule Endoscopy
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History of Small Bowel Imaging
 Radiology
 Small
Bowel Follow Thru
 Angiograms
 Tagged Red Blood Cell Studies
Capsule Endoscopy
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History of Small Bowel Exploration
 Use of colonoscopes
 Sonde Enteroscopes
 Development of push enteroscopes
 Capsule Endoscopy (2001)
 Given;
Olympus; IntroMedics (Korea);
OMOM (China)
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Double Balloon/Single Balloon Enteroscopy
(Japan 2001)
Capsule Endoscopy
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Current Capsule use:
 Small
Bowel
 Obscure
GI bleeding
 Small Bowel Disorders
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Tumors
NSAID ulcers
Celiac/Sprue
Crohn’s Colitis
 Esophageal
 Varicies
 Barrett’s
Esophagus
Capsule Endoscopy – Small Bowel
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Process:
 Prepares
bowel
using standard
colon prep
 Sensor
Array
applied
 Ingest
Capsule
Capsule Endoscopy – Small Bowel
Wait 6-8 hours
Download images
EGD Capsule Placement
Capsule Endoscopy - Esophagus
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Patients typically fast for two hours prior to undergoing the PillCam ESO
procedure. Upon arriving the physician’s office, patients follow the
Simplified Ingestion Procedure (SIP). While standing, a patient will first
drink 100 mL of water. They will then be asked to lie on their right side,
swallow the PillCam ESO video capsule and take one sip of water every
thirty second for seven minutes. After seven minutes, the nurse will instruct
the patient to sit upright, drink another sip of water and wait for thirty
seconds. The PillCam passes naturally with a bowel movement usually
within twenty-four hours.
Nursing Assessment/Education
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Procedure Preparations
 Standard
½
Colon Preparation
Colon Preparation
 Clear
Liquids
Nursing Assessment/Education
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Patient is able to meet time parameters (8 hour study).
Patient has a valid consent.
Patient is responsible to return equipment.
Patient is able to understand and perform colon preparation.
Patient is able to tolerate clear liquid diet.
Patient does not have any swallowing disorders. (Review radiological studies).
Patient does not have or suspected to have a gastrointestinal obstruction. (Review radiological studies).
Patient does not have or suspected to have strictures.
Patient does not have or suspected to have fistulas.
Patient does not have or suspected to have a Zenker's or Meckel's Diverticulum.
Patient does not have a cardiac pacemaker or implanted electromedical devices.
Patient does not have a history of or suspect slow gut transit time.
Patient does not have an MRI scheduled within 1 week of capsule ingestion.
Patient is not pregnant. LMP for women of child bearing ages.
Patient requires EGD for capsule placement.
Type of work. Check for possible electromagnetic issues.
Agile Capsule
Nursing Assessment/Education
Once the capsule is ingested
1. Document the time the capsule was swallowed
2. You may start clear liquids 2 hours after swallowing the capsule. You may take your
necessary medications at this time. **Nothing Red.
3. You may have a light lunch (half sandwich/cup of soup, etc) 4 hours after swallowing
the capsule.
4. You should not be near any source of electromagnetic fields (MRI, Ham radio) or
microwave oven.
5. NO strenuous physical activity, including bending over during the exam.
6. You will need to check the blue light on the top of the data recorder every 15
minutes during the exam. The exam takes approximately 8 hours.
7. DO NOT DISCONNECT the equipment during the exam.
8. DO NOT enter federal or state buildings, airports, or banks with metal detectors
while wearing the recorder.
9. Return to GI Clinic if you have nausea, vomiting or abdominal pain.
Streamlined Functionality – Function
Bar
PillCam SB
Function bar
Progress Indication available for full videos
and only in A-mode
(not in M-mode nor for video segments)
Streamlined Functionality – Tooltips
Place mouse cursor
over any icon on the
RAPID main screen for
Tooltip to display
Capsule Endoscopy
Capsule Endoscopy
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Small Bowel Capsule Images:
Capsule Endoscopy
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Esophageal Images:
FICE LITERATURE REVIEW
Computed Imaging Modification for Enhancement of Small-Bowel Surface Structures at Video
Capsule Endoscopy
By emphasizing lesion hypervascularity and vascular morphology, FICE
might aid in differentiation of neoplastic and non-neoplastic lesions
This novel imaging technique has the
potential to improve the diagnostic
yield of video capsule endoscopy for
obscure gastrointestinal bleeding
Endoscopy 2010;42(6):490-492.
Report Templates
Referring physician’s reason for referral
Template
Localizatio
n
Progress Indicator
1
ON
ON
2
ON
OFF
3
OFF
ON
4
OFF
OFF
???????????????????????????????????????????
???????????????????????????????????????????
Referring physician’s reason for referral
Electronically Signed by: Moti Frisch MD
01/06/2010
RAPID Real-Time v7.0
Standard USB
cable
DR 2
DELL 2100
FEATURES
Key Feature
Comment
Dedicated real-time
only software
• No RAPID Reader
Lower pricing
• Dell 2100 platform lowers costs while maintaining product quality
Functionality
• Touch screen
• Small size enables hand held use
• Support for all PillCam video capsules
Capsule Endoscopy
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Limitations:
 Diagnostic
only
 Can’t control image view/direction
 Cannot inflate the bowel
 Limited field of view
 Still requires bowel prep
 Takes 6-8 hours
 May require EGD to pass capsule
 Capsule can be retained/cause bowel
obstruction
Smart Pill
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Wireless Motility
Capsule
Measures pH, pressure
and temperature
Ingests the capsule
after a meal.
Wears data receiver
for up to 5 days
Excreted in stool after
24-48 hours
Smart Pill
Future of Capsule Endoscopy
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Colon Capsule
Steering
Drug Delivery
Biopsy
Magnetically Guided Capsule
Endoscopy
Swimming Capsules
Robotic Capsules
Drug Delivery Capsules