Kendall Yoshisato, RN, CGRN Capsule Endoscopy Kendall Yoshisato, RN, CGRN Northern CA SGNA September 22, 2012

OBJECTIVES 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 History of Small Bowel Imaging Radiology Small Bowel Follow Thru Angiograms Tagged Red Blood Cell Studies

Capsule Endoscopy Given; Olympus; IntroMedics (Korea); OMOM (China) History of Small Bowel Exploration Use of colonoscopes Sonde Enteroscopes Development of push enteroscopes Capsule Endoscopy (2001) Given; Olympus; IntroMedics (Korea); OMOM (China) Double Balloon/Single Balloon Enteroscopy (Japan 2001)

Capsule Endoscopy Current Capsule use: Small Bowel Esophageal Obscure GI bleeding Small Bowel Disorders Tumors NSAID ulcers Celiac/Sprue Crohn’s Colitis Esophageal Varicies Barrett’s Esophagus

Capsule Endoscopy – Small Bowel 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 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 Procedure Preparations Standard Colon Preparation ½ Colon Preparation Clear Liquids

Nursing Assessment/Education 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 Document the time the capsule was swallowed You may start clear liquids 2 hours after swallowing the capsule. You may take your necessary medications at this time. **Nothing Red. You may have a light lunch (half sandwich/cup of soup, etc) 4 hours after swallowing the capsule. 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. 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. 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 Small Bowel Capsule Images:

Capsule Endoscopy 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 Template Localization Progress Indicator 1 ON 2 OFF 3 Referring physician’s reason for referral Template Localization Progress Indicator 1 ON 2 OFF 3 4 ??????????????????????????????????????????? ??????????????????????????????????????????? Referring physician’s reason for referral Electronically Signed by: Moti Frisch MD 01/06/2010

RAPID Real-Time v7.0 FEATURES Key Feature Comment 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 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 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 Colon Capsule Steering Drug Delivery Biopsy

Magnetically Guided Capsule Endoscopy

Swimming Capsules

Robotic Capsules

Drug Delivery Capsules