Endoscopic Ultra sound for the south Island

Imagine swallowing a pill that can take photographs of your intestine and send them wirelessly to a data recorder so that they can be downloaded, like a movie, for your doctor to review at a computer workstation.

While this may sound like the work of a science fiction novelist, it became a reality in 2002 when The Bowel and Liver Trust raised money for the first capsule endoscopy system available in a public hospital in New Zealand. This work was driven by then Chair of the Bowel and Liver Trust, Mr Martin Howman, who led a team of Trustees to raise the money to provide this important service to Cantabrians.

In the 1970s flexible gastroscopes and colonoscopes had been introduced to examine the stomach and colon, respectively. However, the small intestine, which is between the stomach and colon, has always been difficult to visualise and diagnose diseases in. The advent of Pillcam has changed the way that doctors view the small intestine – the final frontier of gastroenterology. Now patients can undergo a non-invasive test without being admitted to hospital.
The Pillcam was the brainchild of an unlikely combination – an Israeli Astrophysicist and an American Gastroenterologist. Each capsule (the size of a large pill) contains a small camera, a light, a battery and a transmitter. The light flashes twice per second with a photo taken each time. The images are sent wirelessly to a data recorder,
which is worn as a belt around the waist.

As Dale Cornelius, Capsule Nurse, explains, “the patient simply swallows a Pillcam capsule in the morning after an overnight fast. The data recorder is fitted to the patient who can then go about their usual activities for the day before returning to the clinic where the data recorder is removed and the images are downloaded to a computer. Software in the computer converts the images into a video, which can be analysed by a gastroenterologist. Each study takes between 30 and 60 minutes to analyse and report.” Dale Cornelius is currently undergoing training to
assist in interpretation of the studies.
Improvements in technology have led to longer battery life with 10 hours now allowing for the entire small intestine to be easily examined. The angle of the lens has also increased allowing more of the intestine to be examined with
each picture. It is hoped that improvements in software may improve the identification of abnormalities.
Dr Bruce Chapman, Gastroenterologist and Trustee says that a frequently asked question by patients is, “are the capsules reused?” The answer, to the relief of the patient, is “no” with a new capsule being used for every patient. The Pillcam system can be used for all age groups including children and the elderly. Dale Cornelius recently performed a study in an 88-year patient who completed the study with ease.

The Pillcam is very helpful for identifying sources of bleeding in the small intestine, defining extent of
disease in small bowel Crohn’s disease. More rarely it is used to identify polyps and small intestinal tumours. In a review of local cases 59% of those referred with anaemia had a positive finding and in 77% of patients referred
with diarrhoea there was a positive finding.

64397-TBLTC-A4-Newsletter-8pp_HR(1)While some patients have requested a Pillcam instead of a colonoscopy, unfortunately this is currently not an option.
A Pillcam for the colon is under development and prototypes have been tested but there are limitations with the bowel preparation in the colon.

The Pillcam platform is available in Christchurch in both public and private health sectors and serves the upper half
of the South Island. About 100 capsule endoscopy studies are performed at Christchurch Hospital each year, with more than a thousand studies since the system was established in Canterbury in 2002.

Another great success for the Bowel and Liver Trust, improving the gastrointestinal health of New Zealanders.

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