Parliamentary Secretary for Health Chris Fearne, together with gastroenterologist Dr Pierre Ellul and other medical staff announced earlier this week that doctors can now fully examine the small intestine like never before. Dr Fearne announced with great satisfaction that “this is the first time that we can find problems in the small intestine and see how we can deal with them”.
This is a new service which started being used in Malta at the end of last summer. Dr Fearne went on to explain that the capsule, which is about the size of a €1 coin, is swallowed with a glass of water. The capsule contains one or two video chips (cameras), a light bulb, a battery, and a radio transmitter.
Pads attached to the patient’s body transmit the location of the capsule to a small computer in a pack worn by the patient for the duration of the capsule’s journey through the body. It takes two photos per second and takes 100,000 pictures which are transmitted by the radio transmitter to the small receiver within the pack. “The small intestine is around 40m long and we couldn’t access it before this capsule.”
Dr Ellul described the procedure and the uses in more detail, explaining that the capsule is “not simply a substitute for endoscopy or gastroscopy”. The patient swallows the capsule at hospital but is encouraged to go about his daily routine, such as walking and routine housework, “everything apart from contact sports”. The patient then returns to hospital in the evening where the wires are removed and the images downloaded on a computer and watched like a DVD. The patient will then pass the capsule in a bowel movement.
The interpretation of the results takes a little longer than the usual endoscopy results, because viewing the four- to five-hour long video all at once is incredibly tedious. For the best results, doctors “try to split the viewing in bursts of 15 minutes spread over a number of hours and sometimes days”. The total time taken to eject the capsule is about 10 hours, but it depends essentially on the individual patient.
Dr Ellul spoke about using the capsule for inpatients, as well as outpatients. The version used in Malta is specifically for the small intestines; “there are other versions but the international recommendations are very vague and they are not routinely done.” According to Dr Ellul, there are other capsules available, but they are usually only for research purposes.
The procedure has started being used regularly, and requests can be processed in a matter of days depending on patient’s needs. It is used in patients with anaemia, problems with haemoglobin where one might be bleeding internally and a cause was not found by an endoscopy or gastroscopy procedure, inflammatory bowel disease or any other small bowel pathology. It has proved invaluable to differentiate between different types of colitis, or to determine the extent of Crohn’s disease.