Last Modified: March 2, 2003
Dear OncoLink "Ask The Experts,"
I've got a fellow co-worker who has colon cancer and she's had a rough year and they've discovered that with the 1st surgery they didn't get it all. They've done scopes through her mouth and through her rectum and they say that there is a spot where the scopes can't see in the lower bowl and the doctors have suggested trying a new method using a pill that has a camera in it. They say it'll take about 3 days for the pill to go though her system and that it will record data as it does. We've tried to find info on this new way to detect masses within the bowels. Can you please help us find information if you've heard of this new method.
Carolyn Vachani RN, MSN, AOCN, OncoLink's Medical Correspondent, responds:
Thanks for your question. A few things about the video capsule endoscope:
The Food and Drug Administration approved this procedure, in August of 2001, to test for abnormalities in the small bowel (such as bleeding or tumors of the small bowel). There are a few reasons why it has been approved for the small bowel and not the colon, but you should understand the difference between these bowels first.
The small intestine is made up of three parts: the duodenum, the jejunum, and the ileum. In total, the small intestine is a tube-shaped organ, about 21 feet long. After eating a meal, it takes about 1-2 hours for food to reach the small intestine, then another 2 to 6 hours to pass through to the colon (also called the large bowel). The colon is approximately 5 to 6 feet long, and it takes food anywhere from 3 to 8 hours to reach it, depending on the person's diet. The food is then moved into the rectum and expelled.
The video capsule endoscope works by transmitting radio frequency waves that are picked up by a monitor the patient wears on the abdomen during the test. The diameter of the small intestine is much smaller than the colon, which in turn allows the capsule to generate good images of the small bowel, but not of the colon. A second problem is that the video capsule runs on a battery, which has a life of about 8 hours, at which point it stops producing images. You can see that it would be a problem if the capsule did not reach the colon for eight hours and it was no longer working.
Then there is the issue of cost. Medicare and some private insurers will cover the procedure, but only for a few select diagnoses. Colon cancer screening is not one of them. The cost of the test, with the fee for the gastroenterologist to read it, is around $1000. It is important for patients to realize this and check with their insurer before the procedure to avoid being stuck with a bill.
The last issue is the skill and training of the person doing the test. This is true for any procedure, whether it is the video endoscope or a traditional endoscope. In general, the more procedures one performs and the more obscure cases one sees, the better they become. In the case of a serious illness, such as cancer, I will always suggest that the person seek a second, or even third, opinion at an academic medical center or an NCI-designated cancer center. There are other tests available that may be more reliable in detecting the cancer and are more likely to be paid by insurance. These include a barium enema or a double contrast pneumocolon, which are performed at most academic medical centers.