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Heartburn Troubles? Smile, You're on PillCam!

If you are having gastrointestinal troubles, instead of opening wide and saying "ahh," you may want to say "cheese" instead.

That's the idea behind the PillCam, a technology that sends a camera on a tour of your gastrointestinal system. The camera was first used to diagnose intestinal troubles, but is now being used as an alternative to traditional endoscopy, which is more invasive and uncomfortable.

The new procedure has some doctors sounding like teenagers.

"I love this technology, it's so amazingly cool!" says Dr. Ira Schmelkin, chief of the division of gastroenterology at Berkshire Medical Center in Pittsfield, Massachusetts.

A View from the Esophagus
The newest version of the camera pill was approved by the Food and Drug Administration in November 2004 and is designed to help doctors diagnose problems in the esophagus. The PillCamESO is a horse pill of a capsule—11 millimeters wide and 26 millimeters long—which contains miniature cameras on both ends.

The pill is first washed down with a cup of water while the patient is lying on his back. As the camera travels slowly down the esophagus, the patient is elevated bit by bit every two minutes until he is sitting upright to ensure that the camera has gotten through the entire esophagus.

During the approximately 10-minute-long procedure, the camera takes about 14 photos every second, giving doctors a fairly complete view of the inside of the esophagus.

The cameras can pick up objects that are .1 mm in size or larger, so they can help doctors identify even the tiniest abnormalities. Some of these abnormalities may be signs of esophagitis, an inflammation of the esophagus' lining, which is caused by gastroesophageal reflux (GERD) disease, or Barrett's esophagus, a condition that may lead to cancer.

Replacement for a Colonoscopy?
While the PillCamESO is relatively new, its relative, the PillCamSB, has been in use for many years. The older version is designed to examine the small intestine, but there are only a few significant differences in the procedure: namely, the older Pillcam requires a 12-hour fast and takes 8-hours to complete its journey through the intestine. After a patient swallows the camera and the wires are hooked up to the recording device strapped to his waist, the person can go about his day, returning later to have the results of the test read.

Schmelkin reports that he uses the older PillCamSB every day to help him diagnose patients with an array of intestinal problems, including Crohn's disease, tumors, diverticulosis (pockets in the intestine) and even injury from use of non-steroidal anti-inflammatory drugs (NSAIDs).

While Given Imaging, the company that created PillCam, states that the pill cannot be used to replace a colonoscopy to detect colon cancer, but Schmelkin, who has no affiliation with the company, sees the pill as having a future for detecting even this.

"Right now, I absolutely see a role for capsule endoscopy," says Dr. Schmelkin, "Most people would rather swallow a pill than have a 6-foot tube up their colon."

One downside of the pill is that if something irregular is found, such as an intestinal polyp (abnormal lesion), a regular colonoscopy is still needed to determine if it is cancerous.

The Future of the Technology
While the PillCamSB is covered by most insurance companies, the PillCamESO is relatively new, and few insurance companies will cover the procedure at the moment.

The most common side effects of either pill is the small chance that the capsule will become stuck somewhere because of a blockage in the gastrointestinal system. It would require surgery to remove the pill, but, more than likely, these patients would require surgery anyway to correct the blockage. Additionally, the large size of the pill may cause problems for those who have difficulty swallowing.

Although the technology is still relatively new, Schmelkin has high hopes.

"What's really wild about the technology is that patients have had these problems for years and have all sorts of tests done and have never been diagnosed with anything." says Dr. Schmelkin. "And I do the camera pill in one day and come up with an answer."