Capsule Endoscopy

What Is Capsule Endoscopy?

Capsule endoscopy is a purely diagnostic procedure for imaging the mucosa of the digestive tract. For this procedure, the patient swallows a small wireless camera packaged in a capsule and travels through the digestive tract for approximately 9-16 hours. As the capsule passes through the pharynx and esophagus into the stomach and is transported first through the small intestine and then through the colon, the camera illuminates the lumen and automatically takes photos of the mucosa.

These photos, which can number up to 60,000, are sent via radio to a receiver device that the patient wears on the body at all times until the capsule is excreted. Computer software then stitches the numerous photos chronologically and spatially to create a fluid video. A specialist can then evaluate this video, assess all regions' mucosa, and determine possible diseases.

Who Can Benefit from Capsule Endoscopy?

Capsule endoscopies are nowadays primarily used for endoscopies of the small intestine, as this is not entirely accessible with conventional endoscopy. Any suspicion of a small intestine disease generally justifies capsule endoscopy. The most common indications are clarifying bleeding from the intestinal tract that does not originate from the stomach or colon and chronic inflammatory diseases (Crohn's disease), polyps, or other minor intestine diseases.

However, capsule endoscopy can also be used for colon examinations, which is only the case when a conventional colonoscopy has either been unsuccessful or is not practicable due to increased risks such as bleeding or side effects of anesthetics.

There are also cases in which swallowing such a camera capsule is impossible. These include known constrictions in the gastrointestinal tract that could result in obstruction and swallowing problems on the part of the patient, who would run the risk of choking on the camera capsule. In addition, capsule endoscopy should be avoided during pregnancy and MRI examinations.

What Should Be Considered Before the Examination?

Just as with conventional endoscopies of the digestive tract, the bowel should be empty to ensure optimal viewing conditions of the mucosa. In addition, each patient must take a laxative the day before the examination and appear fasting to the examination appointment.

If a patient is suspected of having a narrowing in the intestinal tract, it is essential to clarify this before the examination. For this purpose, an empty capsule of identical dimensions is swallowed. In the case of a narrowed intestinal tract, the capsule dissolves after about 30 hours and disintegrates into smaller pieces that can be excreted without problems. If, however, the capsule can pass through the intestinal tract unhindered, it is excreted as a whole. Then capsule endoscopy can also be carried out.

Are There Any Risks?

As already mentioned, it should be ensured in advance that there are no constrictions in the intestinal tract. In rare cases, however, intestinal obstruction may occur due to the camera capsule, in which case its surgical removal becomes necessary.

How Much Does a Capsule Colonoscopy Cost?

The capsule endoscopy costs about 1300€.

Do Health Insurance Companies Cover the Costs?

Capsule endoscopy of the small intestine as an outpatient examination due to unclear bleeding is covered by private health insurance companies. In other cases, and for inpatient stays, the cost coverage must be clarified in advance. Statutory health insurance companies pay for outpatient capsule endoscopy of the small intestine in justified cases, but usually not for inpatient stays.

For capsule endoscopies of the large intestine, clarification with the insurance company is required in advance, as there is no blanket regulation for these cases.

Public health insurance companies generally reject costs for capsule endoscopies of the esophagus. However, whether private insurance companies in exceptional cases cover them must be clarified individually in case of doubt.

What Is the Experience?

Capsule endoscopy is a relatively comfortable diagnostic examination for patients. It can be performed without anesthesia or narcosis and is very uncomplicated compared to conventional colonoscopy. Patients can even partially follow their daily routine, after the doctor-observed swallowing, before presenting to the doctor again a few hours later. In addition, the physician is not dependent on the direct application of instruments in the intimate area, which some patients refuse to do out of a sense of shame.

According to a study, this patient-friendly aspect could increase the willingness to participate in colorectal cancer screening. Although colorectal cancer is one of the most common types of cancer, far too few citizens undergo such screening.