Published July 2004

Everett Clinic uses pill to image small intestine

Snohomish County Business Journal/ KIMBERLY HILDEN Dr. George Cox of The Everett Clinic displays digital images of a small intestine taken with the M2A Capsule Endoscope.

By Kimberly Hilden
SCBJ Assistant Editor

There’s a digital camera that fits in your pocket, on your wrist and even in your cell phone. But how about one that fits inside a capsule no bigger than a multivitamin — one that can capture more than 50,000 digital photos in a single use?

Although it sounds like something straight out of a James Bond movie, the technology, called a capsule endoscope, can be found at The Everett Clinic, where Dr. George Cox began using it in May to screen patients suffering from ailments of the small intestine.

“Capsule endoscopy represents a new frontier of medical technology,” said Cox, a gastroenterologist. “It is an efficient and painless way to screen patients who have problems with unexplained or obscure bleeding or other small-bowel diseases.”

Developed by Israel-based Given Imaging and approved by the U.S. Food and Drug Administration in August 2001, the M2A Capsule Endoscope is a single-use video color-imaging capsule that measures in at 11 millimeters by 26 millimeters, weighs less than 4 grams and can be naturally excreted by the body.

Once swallowed by the patient, the capsule travels through the intestine, generating images at a rate of two frames per second, according to Given Imaging. Images of the intestinal tract are transmitted by radio frequency to an array of sensors worn around the patient’s abdomen and recorded on a portable data recorder worn around the patient’s waist.

While this eight-hour gastrointestinal exam is under way, the patient continues with his or her daily activities, dropping the recorder off at the doctor’s office at the end of the day, Cox said. There, the images are fed into processing software that produces a video of the small intestine, which can be edited and archived as well as e-mailed to other colleagues for consultation.

And the end result?

“It’s just like watching a DVD,” said Cox, who performed the procedure on five patients during the first month that the technology was available. Of those, three procedures led to indications for treatment, a “high yield” when compared to other diagnostic applications such as CT scans or X-rays accompanied by barium ingestion.

According to Given Imaging, the capsule can help detect objects smaller than one-tenth of a millimeter compared to five-tenths of a millimeter with the X-ray procedure.

It’s a sensitivity that helped one of Cox’s patients, whose X-ray detected nothing but whose capsule endoscopy found numerous ulcers and erosions of the small bowel, indicating the onset of Crohn’s disease, he said.

“Capsule endoscopy may nearly triple diagnostic accuracy over more common X-ray techniques,” he said. “Many patients will benefit from this technology because it identifies problems quickly and is cost effective.”

Cost for the procedure ranges from $800 to $1,200. That compares to $2,000 or more for a specialized CT scan, said Cox, noting that insurance approval for capsule endoscopy in diagnosing obscure gastrointestinal bleeding and Crohn’s disease has grown along with its use nationwide.

Last year alone, 80,000 capsule studies were done in the United States, he said. “It’s a relatively new test, so that number tells you how rapidly it is being accepted.”

Although capsule endoscopy is a noninvasive procedure, there is the risk of capsule obstruction, which could require surgery for its removal, but that risk is “markedly less than 1 percent,” Cox said, noting that patients are pre-screened for the procedure.

“It has been received extremely well by patients,” Cox said of the little camera in a capsule. “It’s easy to do and, clinically, very helpful.”

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