PillCam

Indications (Medicare)

• Previous gastroscopy and colonoscopy which has not identified a cause of:
  • Overt GIT bleeding (melaena or haematochezia)
  • Persistent or recurrent GIT bleeding associated with iron deficiency anaemia (where other causes of anaemia such as coeliac disease have been excluded)
    • In practice this means persistent or recurrent IDA with FOBT+

Contraindications:

• Unable to safely swallow large tablets
• Significant gastroparesis (can still be placed in duodenum with gastroscopy)
• Suspected or confirmed bowel obstruction
• Pregnancy
• Inability to regularly ambulate to encourage bowel motility

Diagnostic utility

• For suspected small bowel bleeding, 56% of patients had a lesion identified
  • SB angiodysplasia 22%
  • SB ulcerations 10%
  • SB tumours 7%
  • SB varices 3%
  • Blood in SB with no lesion 8%
  • Oesophago-gastric lesions 11%
  • Colonic angiodysplasia 2%
• Yield in
  • Overt GIT bleeding 92%
  • Previous overt GIT bleeding 13%
  • FOBT+ and IDA 44%

Preparation

• Eat normally the day before up until midday, then clear fluids
• Fast from 10pm the evening before, continuing until two hours after the capsule has been ingested
• Can sometimes have bowel prep beforehand

Complications

• Retained capsule
  • Higher risk in IBD, with strictures - sometimes do a dummy run
• Incomplete study
• Inability to have MRI scan performed if the capsule has not been passed