GastroEast Physicians - Patient Instructions for CE

Capsule Endoscopy Patient Instructions

Your physician has determined that, as part of your medical evaluation, you should undergo an examination known as Capsule Endoscopy. This procedure involves ingesting a small imaging capsule approximately the size of a large vitamin pill. The Given Imaging M2A Capsule (PillCam) will pass naturally through your digestive system while taking pictures of the intestines. Several sensors attached to your abdomen will receive images transmitted by the capsule. These images will be stored on a walkman-like data recorder which saves all the images. It is placed in the recorder belt, which is worn around your waist. After 8 hours, you will return to the Gastro East GI clinic for removal of the sensors, data recorder and belt. The Capsule is disposable and will be excreted naturally in your bowel movement. DO NOT RETREIVE OR RETURN THE PILLCAM (CAPSULE CAMERA).

Known relative contraindications to Capsule Endoscopy include cardiac pacemakers, defibrillators or other implanted electromagnetic devices, severe intestinal motility disorders, Zenker’s diverticulum, swallowing disorders, small bowel diverticulosis and pregnancy. Please tell your physician if any of these pertain to you.

You must avoid powerful magnets such as MRI machines until the capsule has passed.

In Order to get the most accurate information from your test,
you will need to follow these instructions:

The Day before Capsule Endoscopy

After lunch (noon time) on the day before the Capsule Endoscopy, start a clear liquid diet (apple juice, WHITE grape juice, tea or coffee without milk, clear sodas such as Sprite, clear chicken broth or beef bouillon, clear Jell-O and Popsicles-- Avoid red or purple colored liquids). No solid foods are allowed.

At 7 PM ingest 1 bottle of lime flavored Magnesium Citrate (10 or 12 ounce bottle is OK) and one glass of water (these can be combined or drunk separately). Cherry flavored magnesium citrate should not be used, as it is red in color and may prohibit an accurate reading of your capsule endoscopy exam. Magnesium Citrate can be purchased at any pharmacy (Kroger, Wal-Mart, CVS, etc). This liquid is a laxative and can induce a bowel movement in some people, so be sure to be near a restroom after you drink the Magnesium Citrate.

After 10 PM, the day before your procedure, you should have nothing to eat or drink except for necessary medications with sips of water.

If you have excessive hair on your abdomen, please shave the area 6 inches above and 4 inches below your navel before your procedure, to allow the nurse to apply the sensor pads easily.

Special Cases:

If you are diabetic and taking insulin, take only ½ of your regular dose the day before your capsule endoscopy.
If you are diabetic, drink “regular” sugar containing liquids, rather than sugar-free liquids on the day before the test.
If you are taking iron or iron containing supplements, stop taking them 1 week prior to your scheduled capsule endoscopy.

Day of Capsule Endoscopy:

Do not take any oral medications immediately before undergoing Capsule Endoscopy. If you take medications, take them at least 3 hours before your arrival time, or postpone taking them until 3 hours after you swallow the Pill Cam.
Abstain from smoking 24 hours prior to undergoing Capsule Endoscopy.
If you are diabetic and taking insulin, take only ½ of your regular dose the day of the capsule endoscopy.
Arrive at the Gastro East Clinic, 3950 Kresge Way, Suite 207 at 7:30 AM for your Capsule Endoscopy. Wear loose, comfortable, two-piece clothing. Do not wear dresses, pantyhose or anything restricting around your waist. Try to avoid belts.
You will have a pre-procedure interview. During this time, you will be informed of the small chance of intestinal obstruction or capsule retention. You will be asked to give your informed consent. If capsule retention occurs, the capsule (camera) may need to be removed surgically. This occurrence is rare.
You will given an ounce of Simethicone liquid (Gas-X) to swallow. This medication will reduce the amount of bubbles in your digestive tract to aid in visualization of your small intestine.
The sensor array (EKG-like pads) will be attached with adhesive pads to the abdomen and a belt holding the data recorder will be placed around your waist by the nurse or medical assistant. After that, you will be instructed to ingest the capsule, along with a small glass of water.
Under certain circumstances, especially if you have diabetes, we may provide you a medication called metoclopramide 15 minutes before you swallow the PillCam to help empty the stomach after you ingest the PillCam.

After ingesting the M2A capsule (PillCam):

You may drink clear liquids (water, apple juice, clear sodas such as Sprite, clear chicken broth or beef bouillon-- Avoid red or purple colored liquids), and take necessary medications 3 hours after swallowing the PillCam.
You may eat a light meal or snack 4 hours after swallowing the PillCam.
Do not go near to MRI scanners, until after you have passed the PillCam in your stool.
You will be allowed to leave the clinic after the capsule is ingested. You should not be near any source of powerful electromagnetic fields, such as an MRI device or amateur (ham) radio. Rarely, some images may be lost due to radio interference. This may result in the need to repeat the Capsule Endoscopy examination.
Capsule Endoscopy lasts 8 hours. Do not disconnect the equipment or remove the belt at any time during this period. The data recorder is a small computer and should be treated with utmost care and protection. Avoid sudden movement and banging of the data recorder.
During Capsule Endoscopy, you will need to verify every 15 minutes that the small light on top of the data recorder is blinking twice per second. If, for some reason it stops blinking at this rate, record the time and contact Gastro East Physicians at (502) 893-0220 9 AM to 5 PM Monday through Friday.
Avoid strenuous physical activity while the data recorder is capturing images, especially if it involves sweating. After you have returned the data recorder, regular exercise can resume. We do encourage you to walk periodically during the course of the day, as this may help the capsule move through the intestines.

After completing Capsule Endoscopy:

Return to the Gastro East Clinic, Suite 207 at 4 PM. The equipment (sensor arrays and data recorder with belt) will be removed at that time. The capsule will pass naturally in your stool and does not have to be retrieved.
If you did not positively verify the excretion of the Capsule (PillCam) from your body and you develop unexplained post-procedure nausea, vomiting or abdominal pain, contact the Office during business hours or the Doctor on call after hours.
Undergoing an MRI while the capsule is inside our body may result in serious damage to your intestinal tract or abdominal cavity. If you did not positively verify the excretion of the M2A Capsule from your body, you should contact your physician for evaluation and possible abdominal x-ray before undergoing an MRI examination.

Capsule Endoscopy Reminders:

Wear loose fitting, 2 piece clothing
Do NOT eat solids after noon the day before Capsule Endoscopy
Do NOT eat for 4 hours after ingestion of the capsule.
Return to the clinic promptly at 4 PM to return the equipment.
Call (502) 893-0220 or return to the clinic for questions and problems during Capsule Endoscopy.

Please answer the following questions
and bring this packet with you the day of your exam.

What are you allergic to?
What medications are you currently taking?
Do you have difficulty swallowing, or has food ever gotten stuck in your esophagus requiring removal by a doctor?
Do you have a pacemaker or defibrillator?
Have you ever had a bowel obstruction or blockage, or have you ever had a surgery on your stomach, small intestine or colon?
Are you a diabetic?
Are you pregnant?
What is your height?
What is your weight?
What is your waist size?