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Published on July 8, 2007

Determining the source of gastrointestinal bleeding in the small bowel is not an easy task, but with a new development, doctors can now make a better, easier and more accurate diagnosis, just by having patients swallow a capsule.

The new technology, called Gastrointestinal Wireless Capsule Endoscopy, is a new method of diagnosis that allows doctors to easily examine any abnormal symptoms by giving them images in all directions inside a patient's small bowel, a part of the body that has so far been inaccessible.

As the small bowel, which is the longest portion of the intestinal tract, is located between the stomach and the large bowel, it's hard to reach with instruments introduced either by mouth or anus. Doctors therefore find it difficult to determine any abnormality with the organ, especially when it comes to gastrointestinal bleeding.

Pitulak Aswakul, a gastroenterology physician at Samitivej Sukumvit Hospital, said the difficulty could be overcome.

Today, when doctors suspect that a patient may have a problem in the small bowel, they can use the new method to analyse the symptoms.

Instead of using an instrument for oral or anal passage, which usually cannot reach the small bowel, she said the new method was to use just a small capsule which is swallowed by the patient.

The capsule, 26 millimetres long and 11 millimetres wide, is equipped with a small camera that captures all images inside the patient's gastrointestinal tract.

With an eight-hour battery and a strong light source, the capsule, once swallowed, begins transmitting images of the inside of the oesophagus, stomach and small bowel to a wireless receiver worn by the patient.

Pitulak said the capsule normally takes two colour pictures per second so during the eight hours of its life it captures 55,000 images in total.

All images, she added, are sent directly in real time to the receiver and then after the image-capturing process is complete, doctors load them into a computer to view in detail as the capsule is passes through the intestine.

"This process, which takes around two hours, will help us look for abnormalities inside the small bowel. The screen makes it very easy for us to examine possible sources of bleeding," she said.

The system also comes with an alert function. When any part of the image comes up with a strong red colour, the system sends an alert to allow doctors to take a closer look at the area for further diagnosis.

"The red in the image may mean blood, so the system alerts us to take a look at an area that may be a source of bleeding," she said.

She added that this would help doctors make a more accurate diagnosis to provide better medical treatment and give confidence to patients.

A study indicates that the capsule endoscopy method offers better diagnosis than small bowel X-rays when it comes to finding the cause of bleeding.

It can also be used as an efficient screening tool for patients with a genetic predisposition to small bowel cancer, for small bowel Crohn's disease and for small bowel malabsorption.

Samitivej Sukumvit Hospital has had this technology for three years. A capsule costs Bt30,000 and is for one-time use only, with no side effects on the patient as it exits the body through the normal excretion system.

Pitulak said the total cost to access this diagnosis method was over Bt40,000, but not all patients who had a problem with the digestive system would be examined this way.

"This method is applied on a case-by-case basis, just for those who are prone to problems in the small bowel and have already had their stomach and large bowel checked through conventional gastroscopy and colonoscopy methods, and nothing abnormal has been found in those organs."

Since this method is not a medical treatment but part of the diagnostic process, Pitulak said it could help doctors effectively plan medical treatment while making better predictions about diseases that may occur in the future.

Pongpen Sutharoj