A case review on Capsule Endoscopy

R. Shanthi

Nursing Incharge, Kauvery hospital – Tirunelveli

Abstract

Capsule endoscopy uses a capsule with a tiny camera in it to take pictures of the digestive tract. The capsule is swallowed like a pill and provides images of the patient’s digestive tract for the physician. These pictures are sent to a recorder outside the body. The capsule passes out of the body through the stool within a few days.

Capsule endoscopy is mostly used to check for problems within the small bowel (intestine). These problems include bleeding and tumors. The test can also help diagnose Crohn’s disease, a condition that causes inflammation, sores, and narrowing of the bowel.

Background

A 57years old male came to the casualty with complaints of giddiness for 2 days on and off. History of breathlessness on activity. History of melena 2-3 episodes on and off for past 2 months. Vomiting, 2 episodes.

Known case of CAD, S/P, and PTCA – 2 months back here at Kauvery hospital.

Known case of type 2 diabetes mellitus – 15 years on treatment.

No history of previous surgery.

Examination

Patient conscious, oriented.

HR – 82/mts,
BP – 120/70mmHg,
Tem – 98.6
RR – 20,
SPO2 – 98%
CVS – S1, S2 present,
RS – Bilateral air entry is present,
P/A – Soft,
CNS – NFND

Investigations

Vitals	Values
HB	4.9,
PCV	16.6%
Platelet	2.48L
RBC count	2.46
Total WBC count	8700
Urea	37.8mg/dL
Creatinine	0.97mg/dL
RBS	154mg/dL
Potassium	3.88mEq/L
Sodium	134.4mEq/L
Blood Grouping	A negative
Stool occult blood	Positive
HIV	Negative
HbsAg	Negative
HCV	Negative

UGI Endoscopy report: 18.01.24

Grade B Distal Esophagitis/ Antral gastritis/ Fluid stasis stomach.

Colonoscopy: 22.01.24

Capsule Endoscopy: procedure notes

The patient is asked to wear a recording device on their waist throughout the procedure. This device will record and store pictures taken by the capsule camera as it moves through the gut. Some recording devices even have electrode patches that must be applied onto the skin of the chest or abdomen.
The doctor would ask the patient to swallow the pill-sized wireless video endoscopy capsule with some water.
Once patient swallows the capsule, can get back to daily life for the next 8 hr.
As the capsule journeys through the digestive system, the doctor would instruct to check that the recorder is receiving signals from the capsule.
The doctor would download the pictures, views them on a computer monitor and looks for abnormalities in the intestines.
The capsule leaves the body naturally when there is a bowel movement (poop).

Instructions

After ingesting the capsule, do not eat or drink for 2 hr. After 2 hr you may have After 4 hr, you may have lunch. We recommend liquid

Eat small, frequent meals and avoid spicy or fried food. Probably feel very fatigued for the first 2 weeks then notice a gradual increase in energy thereafter. Fruits and vegetables, fiber and bran in your diet.

Health education

Diet
Drink plenty of liquids.
Avoid consuming alcohol.
Rest.

Medications

After your procedure, you may continue your home medications, as usual, unless an adjustment has been made by your physician.
If you take pain medications or anti-anxiety medications at home, please wait at least 4 to 6 hr, following your procedure, before resuming.

General instruction

Fever of 101°C or more
New abdominal distention or swelling (hard, rigid abdomen) lasting more than a couple of hr.
Increasing abdominal pain, nausea, vomiting and/or the inability to keep liquids down.
Vomiting Blood
Large amounts of rectal bleeding
Shortness of breath
Chest pain

Capsule endoscopy reports

Course in the hospital

A 57 years old male was admitted with above mentioned complaints. Routine &relevant investigations done. Severe anemia HB – 5.3gm. Patient was transfused with 5 units of PRBC. Patient was consulted medical gastroenterologist for complaints of melena. Advised for UGI scope, which showed Grade B Distal Esophagitis/Antral gastritis /fluid stasis stomach. Patient was advised colonoscopy after preparing the patient, which revealed tiny nodule in descending colon. CT Angio of Abdominal Aorta done (22.01.24) which was not significant. Patient underwent Capsule endoscopy, which showed melena feces from jejunum, and beyond, there was suspicious F/O small bowel ectasia in mid jejunum with no active bleed. Nephrologist consulted and advised followed. Patient treated with IV Antibiotic, Oral antihypertensive drugs, anticoagulants, laxative PPI” s and other supportive drugs. Patient was under serial monitoring for anemia. Patient condition improved.

Medications

S. No	Drug	Dose	Frequency
1	Inj. Laricef	1.5gm	BD
2	Inj. Metrogyl	100ml	TDS
3	Inj. Esomac	40 mg	BD
4	Inj. Pan	40 mg	BD
5	Tab. Concor		OD
6	Tab. Deplatt		BD
7	Inj. Pantocid	40 mg	OD

Nursing management

Vital signs are measured to monitor hemodynamic, cardiac, Pain management given. Close observing the patient. Intake and output are measured as a guide to fluid and electrolyte replacement. Completed all necessary documentation including patient notes and discharge documents.

Diet: Fiber Rich Foods

Outcome of the patient

Patient Discharged on 26.01.24. General condition is good, Vitals stable, hence Discharged.

R. Shanthi
Nursing In charge,

A case review on Capsule Endoscopy