IBDanswers

Thomas Stauffer , ARIZONA DAILY STAR

A new camera goes where no such instrument has gone before, chronicling the fantastic journey through your entrails.

While the images taken by the swallowable camera may not be the stuff of Hollywood legend, they're helping doctors uncover problems that have long stymied their efforts to relieve pain.

First administered locally this summer at Tucson Medical Center by Dr. Charles Sanner, the disposable pill-sized camera has allowed doctors to diagnose problems in the small intestine with a new level of accuracy and efficiency, Sanner said.

"With this technology, we can now see an area that could never be seen before," said Julie Giles, endoscopy supervisor at Tucson Medical Center's gastrointestinal laboratory. "You couldn't get there from upstairs or downstairs."

What Giles means by "upstairs" is a standard endoscopy, a scope sent through your throat that eventually snakes through your stomach and a foot or two into your small intestine. "Downstairs" is a colonoscopy, a scope that travels into your colon and eventually reaches about 10 inches into the lower end of your small intestine.

Between the reach of both of those scopes lies about 20 feet of small intestine in the average person.

"It was just very limited what we could do with that area before," said Carolyn Blair, a registered nurse at the lab. "Some people were losing a lot of blood through there, and that's why they were having to have so many blood transfusions, or other people would always have anemia and wouldn't know why."

An Israeli company, Given Imaging Ltd., has changed all that with its swallowable camera-capsule.

The camera, about the size of a robin's egg, may look like a daunting pill to swallow, but the dozen patients Sanner has administered it to haven't had problems swallowing or dispensing the camera, he said.

"There are actually a lot of capsules, such as some calcium tablets, that are much larger than this," he said.

A circle of lights around the tiny camera flashes every second, and the digital imager takes pictures for eight full hours. The patient wears a kind of harness with electrodes that helps the camera receive power from eight batteries, worn like a belt.

Patients simply swallow the pill, wear the harness for eight hours while they go on with their daily lives, then turn in the harness the next day. A disk that records all of the images the camera takes is then fed into a computer.

As for the camera, which costs about $450 but is covered by insurance, it leaves the digestive system much like anything else that gets swallowed, usually about a day later. Sanner said he's not heard any reports of people retrieving the camera for a souvenir.

"We should probably make up little mock models that we could hand out for patients to show to friends," he said.

Colleen Shannon, a registered nurse, swallowed her camera in June, and couldn't have been happier with the results, she said.

"It was very, very fascinating," said Shannon, 48. "When they put the disk into the computer, you could see my teeth, all the way down my esophagus, and everything else."

Shannon said she just went about her daily life after swallowing the camera, and had no problem passing it. That's a far cry from the endoscopies and colonoscopies she's gone through for the last 20 years.

"Even though those aren't that painful, when you have your scopes, you've kind of lost that whole day because you're sedated," she said. "And with a colonoscopy, you have to do a complete program to cleanse your colon before the process, and you spend a lot of time in the bathroom because you have to clean your colon out."

The key benefit of the camera lies in diagnosing what had been undiagnosable sources of gastrointestinal bleeding, Sanner said.

"In the past, people would be put through multiple, multiple procedures looking for the source of bleeding, either endoscopies or colonoscopies," he said. "After that, they often would have to have exploratory surgery to find the source of the bleeding."

The camera can also help uncover ulcers in the small intestine, some of which may be caused by medications that have been administered for stomach ulcers for years that induce ulcers farther down the digestive tract, Sanner said.

It has also been used to diagnose a variety of ills including Crohn's disease, celiac disease and tumors of the small intestine.

Unlike the scopes, which show live real-time images, photos taken by the camera are loaded onto a disk that can be viewed over and over. That means doctors not only have a permanent record of the camera's journey, but also a format that they can reverse, fast-forward, slow down, speed up and freeze, Sanner said.

It's not uncommon for Sanner to spend eight to 12 hours scanning and re-scanning a disk, looking for tiny abnormalities in the small bowel, he said.

Given Imaging already has plans in the works to combine the camera with a laser that would allow the instrument to cauterize or seal up small openings in the intestine or the small intestine.