How to do a capsule endoscopy

Diagnosis of diseases of the small and large intestines

As with all gastrointestinal diseases, a thorough physical examination including the palpation of the rectum by the doctor and the abdominal ultrasound are of great importance.

The Colonic double contrast is a complex, but very informative, contrast medium examination of the large intestine.

The Colonoscopy (Colonoscopy, colonoscopy) is performed to view the entire large intestine from the anus to the appendix (possibly even to the end of the small intestine) with an endoscope over 1 m long. The endoscope is thicker and, above all, longer than the one used for gastroscopy. The colonoscopy is used to assess the intestinal mucosa, the determination of constrictions, e.g. B. by colon cancer, and the detection of benign and malignant growths, for example colon polyps or protuberances (diverticula).

The small colonoscopy(Sigmoidoscopy) works with a shorter, flexible endoscope and allows the assessment of the last 60 cm of the large intestine (the sigmoid colon) and the rectum.

If only the rectum has to be examined, the doctor receives the best results (rectoscopy or rectoscopy) by mirroring with a 30 cm short, rigid and slightly wider rectoscope.

In order for the intestine to be clearly visible, it must be free of stool remains. Therefore, the patient is given a strong laxative the day before the examination in preparation for the colonoscopy. After that, he is only allowed to consume soup and plenty of liquid (at least three liters). The evening before, the intestine is cleaned with an enema. In order to avoid secondary bleeding when taking tissue samples, the coagulation values ​​in the blood are determined before the examination. If you are taking anticoagulant medication, the doctor will decide whether it should be stopped or reduced before the procedure.

Before the examination, the patient is usually given a sedative. At the beginning, the doctor first palpates the rectum with his finger. The movable endoscope is then inserted into the intestine through the anus and carefully pushed forward while supplying small amounts of air.

Secondary bleeding occurs as complication in 2% of the examinations; Penetrations of the intestinal wall are very rare. Furthermore, the sedatives that the patient receives can cause cardiac arrhythmias or a drop in blood pressure. 2 hours after the examination, the patient is usually allowed to go home and eat normally.

New procedures are CT colonoscopy and magnetic resonance colonoscopy, a special type of computer or magnetic resonance tomography in which the doctor can view a precise image of the intestine on a computer monitor. However, since the need for colon cleansing remains, the diagnostic value is controversial and there is no possibility of biopsy, the benefit for the patient has been so far rather minor.

Capsule endoscopy of the intestine. It enables the diagnosis of benign and malignant small bowel tumors. The patient swallows a capsule about 1 cm in size that contains a light source, an electronic camera and a transmitter. The image data are sent to a recipient that the patient wears on their belt and are later evaluated in the computer. Before the examination, the patient does not need to take a laxative, but after swallowing the capsule must not eat or drink for about three hours so that the recordings are not affected too much by bowel movements. The capsule takes the natural route through the intestine and is excreted again at the end. The capsule rarely gets stuck in constrictions or in sacs in the intestine (diverticula) and then has to be surgically removed. Therefore, narrowing of the small intestine (small intestinal stenosis) must be excluded for this examination.

With capsule endoscopy, the patient swallows a small camera and extracts it naturally. During the intestinal passage, the capsule endoscope continuously sends images to an external computer.
Georg Thieme Verlag, Stuttgart

Push enteroscopy. Using a long, flexible endoscope, as in a gastroscopy, first the stomach and then the small intestine up to and including the upper small intestine (jejunum) are examined. A greater pressure ("push") is necessary, which can make the examination uncomfortable.

Double balloon endoscopy. With double balloon endoscopy, the entire small intestine can be viewed and, for example, sources of bleeding can be searched for and obliterated. The endoscope has an inflatable balloon and is placed in a kind of envelope that also has an inflatable balloon. By alternately inflating the balloons and fixing them to the intestinal wall, the endoscope can be advanced piece by piece. Two doctors are required for this examination.

With the Laparoscopy(Laparoscopy), the doctor can not only look directly at the organs in the abdomen, but at the same time also perform a biopsy (tissue sampling) or minor interventions (e.g. removal of the gallbladder or appendicitis). In contrast to the earlier “open” method, only a small abdominal incision in the area of ​​the navel is necessary, through which a tubular endoscope is inserted. In addition, the working instruments are guided into the abdominal cavity with one or two further small incisions. These comparatively small wounds heal more easily and are less painful than large, open abdominal wounds. On the other hand, it is more difficult to get a good picture of the abdomen and, if necessary, to treat complications such as bleeding.

Authors

Dr. med. Arne Schäffler, Dr. Bernadette Andre-Wallis in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 16:24