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Information ⬇

Synonym/Acronym

pill GI endoscopy.

Rationale

To assist in visualization of the gastrointestinal (GI) tract to identify disease such as tumor and inflammation.

Patient Preparation

The patient with an implanted cardiac device should contact their health-care provider (HCP) for evaluation regarding compatibility with the capsule device prior to the procedure. There are no activity restrictions unless by medical direction. Inform the patient to stop taking medications that have a coating effect, such as sucralfate and Pepto-Bismol, 3 days before the procedure; they may prevent the camera from providing clear images. Instruct the patient to abstain from the use of tobacco products for 24 hr prior to the procedure and not to take any medication for 2 hr prior to the procedure, by medical direction. Instruct the patient to start a liquid diet on the day before the procedure; from 2200 the evening before the procedure, the patient should not eat or drink except for necessary medication with a sip of water. Ask the patient to wear loose, two-piece clothing on the day of the procedure because this assists with the placement of the sensors on the patient’s abdomen.

As appropriate, provide information for the patient to take a standard bowel prep the night before the procedure. Protocols may vary among facilities.

Normal Findings

  • Esophageal mucosa is normally yellow-pink. At about 9 in. from the incisor teeth, a pulsation indicates the location of the aortic arch. The gastric mucosa is orange-red and contains rugae. The proximal duodenum is reddish and contains a few longitudinal folds, whereas the distal duodenum has circular folds lined with villi. No abnormal structures or functions are observed in the esophagus, stomach, or duodenum.

Critical Findings and Potential Interventions ⬆ ⬇

N/A

Overview ⬆ ⬇

(Study type: Endoscopy; related body system: Digestive system.)

This outpatient procedure involves ingesting a small (size of a large vitamin pill) capsule that is wireless and contains a small video camera that will pass naturally through the digestive system while taking pictures of the intestine. The capsule contains a camera, light source, radio transmitter, and battery. The patient swallows the capsule, and the camera takes and transmits two images per second. The images are transmitted to a recording device, which saves all images for later review by an HCP. The recording device is approximately the size of a personal compact disk player. It is worn on a belt around the patient’s waist, and the video images are transmitted to aerials taped to the body and are stored on the device. After 8 hr, the device is removed and returned to the HCP for processing. Thousands of images are downloaded onto a computer for viewing by an HCP specialist. The capsule is disposable and will be excreted naturally in the patient’s bowel movements. In the rare case that it is not excreted naturally, it will need to be removed endoscopically or surgically.

Indications ⬆ ⬇

Contraindications ⬆ ⬇

Patients who have had surgery involving the stomach or duodenum, which can make locating the duodenal papilla difficult.

Patients with unstable cardiopulmonary status, a bleeding disorder, blood coagulation defects, known aortic arch aneurysm, large esophageal Zenker diverticulum, recent GI surgery, esophageal varices, known esophageal perforation, or cholangitis (unless the patient received prophylactic antibiotic therapy before the test; otherwise, the examination must be rescheduled).

Patients with swallowing disorders or intestinal blockages or obstructions that may prevent passage of the capsule through the GI tract.

Patients who are unable to have surgery in the case of recovering a retained capsule.

Patients with implanted electronic devices such as pacemakers or cardiac defibrillators because normal function of the implanted device may be affected by the capsule device’s electromagnetic field.

Interfering Factors ⬆ ⬇

Other Considerations

  • Delayed capsule transit times may be a result of narcotic use, somatostatin use, gastroparesis, or drugs used to treat psychiatric illness.

Potential Medical Diagnosis: Clinical Significance of Results ⬆ ⬇

Abnormal Findings Related to

  • Achalasia
  • Acute and chronic gastric and duodenal ulcers
  • Crohn disease, infectious enteritis, and celiac sprue
  • Diverticular disease
  • Duodenal cancer, diverticula, and ulcers
  • Duodenitis
  • Esophageal or pyloric stenosis
  • Esophageal varices
  • Esophagitis or strictures
  • Gastric cancer, tumors, and ulcers
  • Gastritis
  • Hiatal hernia
  • Inflammatory bowel disease
  • Mallory-Weiss syndrome
  • Perforation of the esophagus, stomach, or small bowel
  • Polyps
  • Small bowel tumors
  • Strictures

Nursing Implications ⬆

Before the Study: Planning and Implementation

Teaching the Patient What to Expect

  • Review the procedure with the patient.
  • Discuss how procedure can assist in assessing the esophagus, stomach, and upper intestines for disease.
  • Explain that procedure takes about 30 to 60 min and is started in a GI laboratory or office and lasts approximately 8 hr.
  • Explain that an accurate weight and abdominal girth measurement will be taken before the procedure. No pain will be experienced during the procedure.

Procedural Information

  • The capsule is a single-use device that does not harbor any environmental hazards.
  • The capsule is ingested with a full glass of water that may have simethicone in it to reduce gastric and bile bubbles that may produce unclear images.
  • Additional instructions given to the patient:
    • There is no eating or drinking for at least 2 hr after capsule ingestion.
    • A light snack is permissible after 4 hr.
    • The equipment should not be removed nor should the belt be disconnected at any time during the test.
    • The time and the nature of any corresponding event such as eating or drinking should be recorded if the data recorder stops functioning.
    • A timed diary should be kept for the day detailing the food and liquids ingested and symptoms during the recording period.
    • Avoid any strenuous physical activity, bending, or stooping during the test.

Potential Nursing Actions

Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.

  • Verify the patient is able to swallow without aspiration risk.
  • Ensure that the patient with an implanted cardiac device has been cleared to have the procedure.

Safety Considerations

  • The patient should be instructed to avoid close proximity to any strong electromagnetic source, such as magnetic resonance imaging (MRI) or amateur (ham) radio equipment until the capsule has been eliminated from the body; magnetic fields can disrupt the function of the capsule device and serious damage could be caused to the patient’s GI tract if the patient is exposed to the strong magnetic force of MRI equipment.

After the Study: Implementation & Evaluation Potential Nursing Actions

Avoiding Complications

  • Possibility of intestinal obstruction is associated with the procedure.
  • Obtain posttest weight and abdominal girth; comparison of pre- and posttest measurements may assist in early identification and resolution of obstruction or retained capsule.
  • Emphasize that any abdominal pain, fever, nausea, vomiting, or difficulty breathing must be immediately reported to the HCP.

Treatment Considerations

  • Follow postprocedure vital sign and assessment protocol.
  • Instruct the patient to remove the recorder and return it to the HCP.
  • Ask the patient to verify the elimination of the capsule but not to retrieve the capsule.
  • Resume normal activity, medication, and diet after the test is ended or as tolerated after the examination as the HCP directs.
  • Interventions/actions related to the disease process include the following: Assess bowel sounds. Measure abdominal girth to monitor degree of abdominal distention. Keep NPO as required with implementation of fluid and electrolyte replacement strategies. Initiate ordered nasogastric intubation (NGT), and monitor for patency and amount of drainage. Assess hydration status (fluid deficit, overload). Perform a daily weight. Monitor and trend laboratory studies: BUN, Cr, Hgb, Hct, and electrolytes. Administer ordered antiemetics, analgesics, or antibiotics. Ensure strict intake and output.

Safety Considerations

  • Patients with an NGT should have placement verified according to best practice guidelines and organizational policy.

Nutritional Considerations

  • Dietary changes may be necessary based on prognosis to meet therapeutic goals.
  • Dietary consult with a registered dietitian can assist the patient to structure diet changes to meet therapeutic and cultural needs.

Clinical Judgement

  • Consider how to emphasize that strict adherence to study guidelines will provide positive health benefits.

Follow-Up Evaluation and Desired Outcomes

  • Recognizes colon cancer screening options and understands that decisions regarding the need for and frequency of occult blood testing, colonoscopy, or other cancer screening procedures may be made after consultation with the HCP.
  • The most current guidelines for colon cancer screening of the general population as well as of individuals with increased risk are available from the American Cancer Society (www .cancer.org), U.S. Preventive Services Task Force (www.uspreventiveservices taskforce.org), and American College of Gastroenterology (www.gi.org). For additional information regarding screening guidelines, refer to the study titled “Colonoscopy.”
  • Understands that Colonoscopy should be used to follow up abnormal findings obtained by any of the screening tests.