Small Bowel Capsule Endoscopy

Small bowel capsule endoscopy is a procedure performed as an outpatient which allows us to examine your entire small bowel. The small bowel is part of the gut between the stomach and large bowel. We will ask you to swallow a small video capsule (23 millimetres long, about the size of a large vitamin pill). The capsule has its own camera and light source.

The video recording may, and procedure may last up to 13 hours, this could last longer as the capsule needs to pass for it to be deemed as a completed procedure, but you should be able to carry on most of your usual daily activities as normal.

You will need to wear a belt which contains sensors. The camera will send information to these sensors which record the pictures of your small bowel. During the procedure you should move around as this helps the capsule to pass through the small bowel. Most patients find the procedure comfortable.

The most common reason for performing a capsule endoscopy is to help your doctor determine the cause of recurrent or persistent symptoms such as abdominal pain, diarrhoea, unexplained anaemia, or bleeding.

In most cases, a patient will have a camera procedure (endoscopy) of the stomach (gastroscopy) and/or large bowel (colonoscopy) before a small bowel capsule endoscopy is considered.

If your small bowel is not empty enough at the time of the procedure, we may need to repeat the procedure. If this happens you will be asked to take medication to clean your small bowel the day before.

There is a small risk (around four in one hundred patients) of the capsule getting stuck in the bowel. The level of risk depends on the medical problem which is causing your symptoms. If we are concerned that the risk for you is high, you may be asked to swallow a capsule which breaks down in the bowel (a patency capsule) a few days before the actual procedure. This is to ensure that your small bowel does not contain any areas of narrowing (called strictures).

In a very small number of cases, the capsule does not pass from your stomach into your small bowel during the time it is recording. This does not mean that there is anything wrong and the capsule will usually move through the bowel with time. If this happens, we can do the procedure again, placing a new capsule directly into your small bowel using an endoscope. This is done under sedation or a short general anaesthetic.

The most common reason for the capsule not passing through the small bowel is inflammation or narrowing of the bowel from Crohn’s Disease. Treatment with anti- inflammatory medication may allow the narrowed part of bowel to heal. This may allow the capsule to pass through by itself. If the capsule is stuck at the top or the bottom of the small bowel it may be possible to retrieve it using an endoscope. In rare cases the small bowel can be severely ulcerated, scarred or blocked and an operation may be needed to remove the capsule and to treat the disease.

You must not have a capsule endoscopy if you are pregnant.

You must inform us if you have a pacemaker, an artificial heart valve, intracranial clips, a cerebral shunt, a cochlear implant or an internal electromedical device, have had previous abdominal surgery, have a swallowing problem or a previous history of blockages in the bowel. Having one of these conditions may mean a capsule endoscopy cannot be done safely.

For some patients, the small bowel capsule endoscopy can be done at home. If this applies to you, a courier will deliver all the equipment you need the day before your procedure. This may include the belt, recorder, shoulder bag, paperwork, and Moviprep® if required.

In some cases, newer equipment called GI Genius™ may be used instead. This uses a small sticky sensor that attaches to your abdomen, so no belt or recorder is needed.

On the day of your procedure, a member of staff will have a video call with you to show you how to put on the belt and recorder (if applicable). You will then swallow the capsule and continue your normal daily activities.

The following day, a courier will collect the equipment so we can download and review your small bowel images.

There is a video on our Endoscopy Unit page with more information about having a capsule endoscopy at home.

You may be given a bowel cleansing drink called Moviprep® to help ensure clear views of your small bowel, especially the lower part.

Not everyone needs to take Moviprep®, but many patients benefit from it, particularly those with slow stomach emptying, slow bowel movements, or who are taking medications that can slow the gut.

In some cases, the reason for your procedure may also require a very clean small bowel to get the best images.

Moviprep® is generally very safe, but there is a risk of developing dehydration, low blood pressure or kidney problems with this medication.

People who are more at risk of dehydration include:

• frail or elderly people
• children
• people with kidney, heart, or liver problems
• people taking water tablets (diuretics)

Moviprep® is designed to be safe even for these groups, so the risk is very low.

If you are pregnant or think you might be, do not take Moviprep®. Contact the Endoscopy Unit for advice.

Side effects can vary from person to person. You may feel sick, bloated, or have stomach pain. Your bottom may become sore, and you might feel dehydrated, so remember to drink plenty of fluids. If you notice a rash, itching, redness, or swelling, seek medical advice straight away.

Tablets and other oral medication should not be taken within one hour of Moviprep® as they may be flushed through too quickly and not absorbed so they will not work properly.

You should follow any specific advice you have been given with regard to your regular medications. Your doctor may ask you to stop medicines such as:

• diuretics (water tablets)
• non-steroidal anti-inflammatory drugs (NSAID) such as ibuprofen

Note: Patients taking immunosuppressant medication for transplanted organs should seek the advice of their transplant doctor before taking Moviprep®, as it might mean the anti-rejection drugs work less well.

Women taking the oral contraceptive pill should take alternative precautions during the seven days following taking Moviprep®, as the pill may not work.

It is very important that you follow the dietary advice below before the procedure so that there is a clear view of the lining of your small bowel.

14 Days Before Your Procedure

If you are taking medicines that can slow down the stomach, such as Ozempic® or Mounjaro®, stop these.

Seven Days Before Your Procedure

Stop taking iron tablets until after your procedure.

If you are diabetic and take insulin or diabetic tablets, contact the Capsule Endoscopy Nurse for advice. Always speak to your doctor or the Capsule Endoscopy Nurse before making any changes to your medication.

Five Days Before Your Capsule Endoscopy

Stop taking any medications that can cause slow bowel movements, such as Imodium®, Lomotil®, or medications containing opiates (for example, codeine phosphate).

Continue taking all other medications as usual, including any laxatives, until after your appointment.

During the five days before your procedure, aim to increase your fluid intake to at least two litres of clear fluids or water per day (around eight to ten glasses) and continue this until the day of your procedure.

Do not eat high-fibre foods such as wholemeal bread, cereals, fruit, fruit juice, vegetables, nuts, seeds, salad, or muesli. Avoid eating red meat.

Please avoid these foods, as they can make it difficult to obtain clear images of your bowel, and the procedure may not be as effective.

• Cereals: Rice Krispies®, Cornflakes
• Bread: White bread, white toast, white rolls
• Rice & Pasta: White rice, white pasta
• Potatoes: Boiled, mashed, fried, or baked (do not eat the skin)
• Meat/Fish: Chicken, turkey, fish, tuna, sardines (plain)
• Eggs: Scrambled, fried, poached, or boiled
• Dairy: Milk, butter, margarine, cheese, plain yogurt
• Fats & Oils: Olive, canola, or soy oil; mayonnaise
• Soups: Clear chicken broth (no vegetables)
• Spreads: Seedless jam, Marmite®
• Vegetarian Options: Tofu, plain soya products
• Other: Chocolates and candies (without fruit or nuts), chewing gum, boiled sweets (clear)

Foods to avoid (Forbidden)

• High-fibre cereals: granola, muesli, bran, wholegrain or mixed-grain cereals
• Wholemeal/wholegrain bread, rye or seeded bread
• Brown rice, wholewheat pasta, grains (quinoa, barley, bulgur)
• Red meat, processed or seasoned meats (with herbs/spices)
• Soups with vegetables
• Peanut butter, nut spreads, jams with seeds or fruit pieces
• Legumes (beans, peas, corn, chickpeas, lentils, soya with added fibre)
• Fruits with seeds: strawberries, raspberries, blackberries, kiwi, tomatoes, cucumbers (with seeds), corn

Acceptable clear liquids

Apple juice, white grape juice, tea or black coffee (without milk), water, clear carbonated or sports drinks, plain jelly, Ice lollies, chewing gum, or boiled sweets (dissolve slowly).

Do not have any red or purple-coloured drinks.

Clear jelly is permitted.

You may also have clear strained soup, but no broth or thick soup.

Have a good breakfast using foods from the permitted list.

You may have a light snack until 11:00 AM. After 11:00 AM, do not eat any solid food until after your procedure, but drink plenty of clear fluids (as detailed above).

If you have been given an oral laxative, continue fasting and drinking clear fluids. Follow the instructions provided for the timings of when to take your laxative.

If you’ve been given Moviprep®

Most patients only need one packet of Moviprep®, but some may need two packets. Please follow the instructions below.

If one packet was given:

• Mix sachets A and B with 1 litre of water at 7:00 PM the night before your procedure
• Drink it slowly over two hours.
• Continue with fasting and clear fluids.

If 2 packets were given:

• First dose: Mix sachets A and B with 1 litre of water at 7:00 PM the night before your procedure and drink it slowly over two hours. Continue with fasting and clear fluids.
• Second dose: Mix sachets A and B with 1 litre of water at 6:00 AM on the morning of your procedure and drink it slowly over two hours. Continue with fasting and clear fluids.

Moviprep® helps clean your bowel before the procedure. After you start drinking it, you will have frequent, loose bowel movements. This shows it’s working.

Stay near a toilet, as you may need to go several times. You might feel some bloating or cramps, which should ease once your bowel is clear.

To prevent soreness, apply a thin layer of Vaseline®, Sudocrem®, or Drapolene® after using the toilet.

Drink plenty of clear fluids to stay hydrated.

If you feel unwell or cannot keep the drink down, contact the Capsule Endoscopy Nurse or the Endoscopy Unit for advice.

Please wear a comfortable, loose-fitting shirt or vest when you come for your procedure.

Bring a list of all the medications you are currently taking.

Arrive at the Endoscopy Unit reception at the time given on your appointment letter. A member of staff will meet you there.

We will ask you a few questions about your health and medications, explain the procedure, and then ask you to sign a consent form before we begin.

By law we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves. Staff will explain all the risks, benefits and alternatives before they ask you to sign the form. If you are unsure about any aspect of the procedure, please speak with a member of staff again. Remember that if you change your mind you can withdraw your consent at any time.

It may be helpful for you to write down any questions or concerns you have as a reminder so that you make sure you ask about them. Please contact us before the procedure if you wish to discuss anything.

We will attach the equipment, and you will then swallow the capsule with some water. You will need to stay in the hospital for about 30 minutes.

After this, we will check the capsule’s position. If it has not moved into the small bowel, we may give you a tablet to help it get there. Once everything is fine, you can go home.

The capsule will move through your digestive system, taking pictures and sending them to a small recorder that you carry in a shoulder bag. The procedure ends when the battery runs out (after about 13 hours) or when you see the capsule pass in your stool.

Eating and drinking instructions after swallowing the capsule:

• After 2 hours: You can start drinking small sips of water.
• After 4 hours: You may have a light meal.
• After 8 hours: You can return to your normal diet.

During the procedure, check every 30 minutes to make sure the light on top of the recorder is blinking blue. This shows the capsule is actively sending images to the recorder.

If the light turns orange or stops blinking while the capsule has not yet passed and the battery is still on, write down the time and contact the Capsule Endoscopy Nurse Practitioner (see Section 18).

Avoid exercise or any hard physical activity, especially bending or anything that makes you sweat. If you feel abdominal pain, nausea, or vomiting during the procedure, contact the Capsule Endoscopy Nurse Practitioner.

If the capsule has passed through, or after 13 hours the recorder flashes red continuously and then stops blinking, you can remove the equipment. Take off the shoulder strap and recorder, undo the belt, and keep all the equipment together. There is no need to disconnect the belt from the recorder.

Once the procedure is completed, you can remove the sensor belt and recorder and return them to the Endoscopy Unit the next morning. Please do this promptly so that we can check the video recording for any issues and prepare the equipment for the next patient.

The capsule is disposable and does not need to be returned.

The images acquired during your procedure will be reviewed after the procedure

Please contact us if you experience any problems after the procedure, such as persistent abdominal pain, nausea, or vomiting.

You must not have a Magnetic Resonance Imaging (MRI) scan until the capsule has passed out of your body. Please contact the Capsule Endoscopy Nurse for further advice (see How does the capsule pass out of the body? below).

The capsule is disposable and passes out with your stool. You should not feel any pain or discomfort when this happens and you may not notice it at all. Please do not worry if you do not notice the capsule has passed out. We will review the images to see if the capsule has reached the large bowel. If the capsule has not reached the large bowel we will contact you and let you know what to do.

Results may take up to 4 weeks to process. This is because it takes time to carefully review the large number of images. The results will be sent to the clinician who referred you.

Capsule Endoscopy Booking Co-ordinator (appointment bookings and dietary advice before the procedure, Monday to Friday 09:00-17:00)
Direct line: 020 3447 7546
Switchboard: 0845 155 5000 / 020 3456 7890 ext. 75496
E-mail: uclh.referrals.VCE@nhs.net

Endoscopy Capsule Nurse Practitioner (medical queries and queries after the procedure has begun, Monday to Friday 09:00-17:00)
Mobile: 07973 720116

Endoscopy Recovery (Monday to Friday 09:00-17:00)
Direct line: 020 3447 3282
Switchboard: 0845 155 5000 / 020 3456 7890 ext. 73282

On-call Gastroenterology Registrar (out of hours emergencies only)
Switchboard: 0845 155 5000 / 020 3456 7890

Address: Endoscopy Unit, University College Hospital, 2nd Floor Podium, 235 Euston Road, London, NW1 2BU