UHealth First in the World to Deploy New Endoscopy Technology for Small Bowel Imaging
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Article Summary
- An updated small bowel video capsule endoscopy technology debuted at University of Miami Health System Dec. 10.
- Capsule endoscopy involves a patient swallowing a pill-size camera, which takes pictures to be watched and interpreted by gastroenterologists.
- Technological advances will increase patient access to endoscopy and improve comfort and convenience.
An updated small bowel video capsule endoscopy technology made its world debut at UHealth—University of Miami Health System on Dec. 10. The upgrade offers not only patient convenience but also improved access to care for patients who may have small bowel pathologies.
Approved by the FDA for use in 2001, capsule endoscopy involves a patient swallowing a pill-size camera, which takes pictures to be watched and interpreted by gastroenterologists.
The technology was developed to allow evaluation of the small bowel mucosa, an area that has historically been challenging to image. While a CAT scan could capture external images, prior to capsule endoscopy the only way to view the lining of the small bowel was by invasive and challenging device-assisted enteroscopy.
“Capsule endoscopy allows us to take the 20 to 22 feet of small bowel and be able to see it relatively easily and to be able to understand if there’s a lesion. That’s the first big question. And then, if there is a lesion, to guide what the next steps are in terms of management,” said Jodie Barkin, M.D., director of pancreatic and small bowel diseases and associate professor in the University of Miami Miller School of Medicine’s Division of Digestive Health and Liver Diseases.
Imaging Small Bowel Disease
“Capsule endoscopy is the primary modality of assessment of the small bowel mucosa in patients with suspected small bowel bleeding and is the foundation of our clinical and endoscopic approach,” Dr. Barkin said. “For patients with Crohn’s, we use capsule endoscopy to assess the severity of disease, assess involvement and response to therapy. If we see inflammation or ulcers, that would guide therapies. Then one way to monitor disease activity or response to therapy in the small bowel is with capsule endoscopy.”
Less commonly, capsule endoscopy is used to image the small bowel for patients with hereditary polyposis syndrome, to screen patients who may be at increased risk of small bowel cancers and to assess patients with refractory celiac disease.
Capsule Endoscopy Improvements
Capsule endoscopy has undergone several major improvements since its initial release. For instance, the cameras themselves now have higher definition, better resolution and faster frame rates for imaging the small bowel.
“If you think about what TVs or computer monitors were like in 2001, they were great at that point, but now we’d see the pictures as grainy compared to today’s ultra-high-definition screens,” said Dr. Barkin.
But the biggest improvement in the newest capsule endoscopy product, Medtronic’s PillCam™ SB 3 capsule endoscopy system, is the receiver, the PillCam™ Genius Link Device, which is the part of the device worn by the patient to capture the images taken by the camera.
Patients in 2001 who tried the first version of capsule endoscopy wore a belt and a large sensor vest, which captured information from electrodes pasted on the patient’s abdomen.
“It looked kind of like a cross between a tactical vest and an EKG,” said Dr. Barkin. “Patients had to carry this big, bulky heavy equipment around all day. You couldn’t do anything else because it didn’t fit under your clothes. It would have been challenging to go to work with the original sensor vest on. And while technological improvements to the belt and receiver have been made over the years, they still remain cumbersome to patients. They also have the potential to lose contact with patient movements, which leads to potential skip areas in the created video.”
The new device condenses the bulky equipment of the old receiver into a sticker worn on the patient’s abdomen under the clothes. Since there’s no danger of the sticker losing contact with the skin, the receiver is less disruptive to patients’ everyday lives. At the end of the study, patients pull off the sticker and return it to their doctor for image downloading and video creation.
Improved Patient Access
For Dr. Barkin, that means not only convenience for patients, but the chance to treat more patients. With the old equipment, the endoscopy unit would need to wait for patients to return the equipment before staff could recharge it and then issue it to a new patient.
“With the new device technology, we can accommodate as many patients as we need to on a specific day because the equipment is single use,” Dr. Barkin said. “We now no longer have to worry about having to cancel outpatients who need capsule endoscopy if we have an inpatient who needs an urgent procedure or if a receiver is returned late. It’s a huge leap forward for us as a practice and a health system and it directly impacts patient care.”
Dr. Barkin anticipates eventually being able to deploy the new system at UM’s satellite endoscopic facilities.
“Right now, we only offer capsule endoscopy at UHealth Tower and therefore can’t pair capsule endoscopy procedures with other procedures such as upper endoscopy or colonoscopy that may be scheduled at the same time if the patient is not having the procedure done at the Tower,” he said. “For patients who may have mobility issues in not only getting downtown but also returning the device, it’s challenging. But eventually we’ll be able to expand to our other endoscopic facilities. Ultimately, this will allow us to increase the points of care in our health system, benefitting the patients we serve.”
UM has the distinction of being first in the world to use this new capsule endoscopy receiver device.
“We are very proud to be the first system to use this updated technology,” Dr. Barkin said. “But most of all, we’re pleased to be able to offer it to our patients.”
Tags: Division of Digestive Health and Liver Diseases, Division of Gastroenterology, Dr. Jodie Barkin, endoscopy, gastroenterology
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