Pill-sized cameras offer insight

The new procedure takes about 20 minutes and requires no recovery time.
PHILADELPHIA -- When Joseph Nigro's doctor wanted to check him for bleeding deep in his throat, Nigro typically would have had to fast for eight hours, get drugged up and endure a long tube threaded down his gullet.
Instead, all he did was gulp down a camera -- the size of a vitamin pill.
"It's like swallowing an aspirin," said Nigro, 71, of West Chester, Pa. "It's not much different."
The PillCam ESO, which passes naturally out of the body in eight to 72 hours, gives patients a new way to be screened for abnormalities in the esophagus.
With just a few swigs of water, the camera slides down the esophageal tract, lights flashing from both ends of the pill, and takes 2,600 images -- 14 per second -- for quick diagnosis while minimizing patients' discomfort and hospital time.
Patients "can come in over their lunch break," said Dr. Anthony Infantolino, clinical assistant professor of medicine at Thomas Jefferson University Medical Center.
Technology helps
The PillCam is only the latest example of how cameras and computers keep getting smaller and more powerful, making medical procedures less invasive. A version of the PillCam can already scope out problems in the small bowel, a notoriously difficult region to examine.
Unlike the endoscope, the PillCam cannot be directed to or linger on specific parts of the esophagus. It captures whatever it sees as it slides down naturally. The images may be less clear as well.
"What it sees is what it sees," said Ben Krevsky, director of gastrointestinal endoscopy at Temple University Hospital, who also uses the device.
Still, many are eager to use the pill. Jefferson was one of about a dozen U.S. sites that conducted pilot research on the device. To date, it has used the PillCam ESO in about 100 patients, Infantolino said.
How it works
The patient ingests the camera lying down. As the device moves down the esophagus, its transmitter sends images to a hard drive worn by the patient. Once the shots are complete in four to five minutes, they are downloaded and read by the doctor. The total process can last just 20 minutes.
The PillCam may be particularly good for patients with serious illnesses such as liver disease who are poor candidates for more involved medical procedures, said Infantolino.
While many doctors around the country use the device and speak highly of it, there are no published studies of its diagnostic accuracy compared with the endoscope, Krevsky said.
Also, because the esophagus collapses if no air is in it, it can be difficult to take clear pictures. The endoscope can inflate the airway, producing better views of the esophagus for the doctor, said Krevsky.
Like many new medical devices, insurance companies are not consistently paying for the PillCam ESO. The device alone costs $450 a pop, and patients pay about $1,000 for one visit to the doctor for a PillCam.
More advances
In the next six months, Jefferson plans to study a new camera that allows for real-time image viewing, said Infantolino. Doctors can give live feedback to their patients as they watch the images together.
The SmartPill is another new device. It measures the functioning of the gastrointestinal tract, including acidity and pressure, said Henry Parkman, director of the Gastroenterology Motility Laboratory at Temple University Hospital. Temple is involved in trials to get the new SmartPill approved.
Some people's stomachs empty more slowly than others, and this prolonged movement can cause nausea and pain.
The length of time recorded between the high acidity in the stomach and the lower acidity in the digestive areas surrounding the intestine indicates the speed with which the stomach empties.

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