Wednesday, February 24, 2016

A Fantastic Endoscopic Voyage

By: Christopher P. Shaver, MD, Birmingham Gastroenterology

The Fantastic Voyage was a 1966 science fiction film about a team of scientists miniaturized and injected into the body of a world-renowned scientist dying of a brain aneurysm. Their mission was to pilot their mini-submarine to the depths of his brain to perform life-saving neurosurgery.

At Birmingham Gastroenterology Associates, we have the endoscopic technology to perform our own fantastic voyages. This voyage involves the endoscopic surveillance of the entire length of the small intestine. The human small intestine spans an average length of twenty-two feet. Due to its lengthy anatomy and relative inaccessibility, the direct inspection of this very important segment of the digestive tract was difficult. Consequently, a good look at the interior of the small intestinal tract was reserved for risky, low yield, and last resort operations.

The advent of the wireless video capsule changed all of that. The pill camera is an ingestible, wireless video camera that puts your Go Pro to shame. During its eight-hour battery life, its takes no less than 50,000 images. The images are uploaded into a sophisticated workstation producing a high definition video of the entire small intestine. The procedure is painless and the pill camera is disposable. A physician makes expert recommendations regarding future diagnostics and therapy based on the findings.

We utilize video capsule endoscopy primarily for the evaluation of two common conditions: undetectable gastrointestinal bleeding and unexplained, chronic diarrhea.

GI bleeding, often associated with chronic anemia, is frequently encountered in our patients. Though its source is usually easily identified, five percent of gastrointestinal bleeding events occur beyond the reach of conventional endoscopy. In this era of powerful blood thinning medications used to treat various cardiovascular and hematologic diseases, both overt and obscure GI bleeding events are quite common. Fortunately, we have a powerful diagnostic tool to shine a light on the depths of the gut previously beyond our reach.

Diarrhea is common symptom that significantly restricts the quality of life of many of our patients. Though routinely diagnosed and treated in a routine and uncomplicated fashion, its cause is occasionally elusive and the symptoms sometimes refractory. In situations where small intestinal inflammation is suspected, video capsule imaging is very helpful in inspecting the small intestinal lining for signs of damage.

Indications for wireless capsule endoscopy are expanding into the realms of celiac disease, hereditary polyposis syndromes, and malabsorption. Though not widely available, other novel uses for wireless capsule technology include Barrett esophagus screening and non-invasive colonic inspection. The wireless Smartpill is also available which assesses intestinal motility based on pressure, ph and temperature readings.

Well, the Fantastic Voyage ended well. Despite many close calls and the attempted sabotage of the mission, the brave medical pioneers successfully completed their mission by saving the scientist and returning home safely. The good news for our patients is that fantastic voyages in gastroenterology are no longer science fiction.

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