Here's 'The Skinny' On My Possible Pill Camera Endoscopy

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Date Joined May 2003
Total Posts : 9448
   Posted 1/10/2008 3:05 PM (GMT -7)   
Okay, here's the skinny on my possible/likely Pill Camera Endoscopy:

Since I'm one of the "odd-ball" crohnies who tends to constipation and my gut left to its own devices only parts w/its contents once every 3-4 days I am to keep a diary of my BMs for the next two weeks. Then in to see my gastro to make the final decision and most likely to schedule the dissolvable pill swallow to make sure the PCE will move thru w/o getting stuck or permanently stuck.

Now, as curious as I am to see and know what is going on in "the dark continent" of my small intestine I really wanna do this - but I just finished a regimen of pred and the gut is happy as a lark so who wants to go to the time and expense of the PCE to see nuttin'??? I'm thinking we should wait until the gut decides to act up again. On the other hand, both my gastro and now, finally, her NP have my "number" and know that my curiosity makes me a good candidate to concede to their suggestion to do it now. I've gotta think this thru a bit more. I don't wanna waste this "opportunity" to know what is going on where!

They "might" want me to do a/the colonoscopy prep because of the tendency to constipation. Hmmmmm. And done before hand that is to help how? The usual "prep" is just a liquid diet 24 hours before and NPO for 10 hours prior. I can live w/that easily enough except I do dehydrate quickly and easily.

This dissolvable PCE has the proprietary name of "Agile Patency System". Of course it is the same size as the PCE itself. Despite what appears to be intestinal narrowing in a radiographic image, the stricture may be flexible or functionally patent allowing a solid object the size of the PCE to pass. Passage of the APS pill indicates and provides assurance the PCE can be performed safely and should not lead to PCE retention.

Hmmm, the APS and PCE are sure honkers in size!!! The APS has a lactose body w/10% barium to enable xray visualization and contains a Radio Frequency Identification tag to determine capsule location. Timer plugs at each end of the APS capsule facilitates controlled disintegration of the capsule body. The "timer plugs" dissolve first, they are on the two ends of the APS capsule.

The APS procedure doesn't have a specific CPT code so the use of the Miscellaneous CPT code 91299 may be appropriate. Coverage and payment varies by insurance.

So that's where we stand. Unless we decide to wait to do the APS and possible PCE until my next flare I see the gastro or NP in two weeks and we proceed as above.

I'll be curious to see the contraption we wear that captures the data from the PCE as so many have mumbled and grumbled about its size and weight. I'd have thought it wouldn't be much different than wearing a holter monitor for 24 hours but we shall see when it comes the time.

So: Day 0 Prep, Day 1 Swallow the APS. Day 2 (28-30 hours after swallowing the APS) APS Scanner or xray - my gastro's NP said xray). IF APS is not seen, success! we can go ahead and schedule the PCE. If the APC is still present .... no PCE in my future.

Immediately after ingestion of the APC, hold the AP scanner near and parallel to my abdomen to detect the capsule. Record ingestion time on Bowel Movement Activity Form. I'm to record any bowel movement I may have between ingestion and the scan/xray 28-30 hours after ingestion.
OOOOPS! ALMOST FORGOT! The hospital where she does this PCE procedure (NOT my favorite hospital in town by the way - grrrrrrr) CAN make a CD/DVD of the PCE procedure but most likely wouldn't provide a copy of the reader software so altho they could give me a disk I probably would not be able to view the procedure on my 'puter. I was disappointed but said I would want a copy anyway. When and if the time comes that I would need another resection I'm off to Mayo in a heartbeat and I prefer to provide Mayo w/just the raw data rather than the dictated reports anyway and Mayo for sure does have the software to read the CD/DVD. So I will be given a copy. I'll also be given printed still pictures of any "views" the doctor deems of interest.
AND: doctor does sit and watch the "films" taken, but there are like 4 to the screen and it takes only 2 hours vs the actual filming time.
Oh, one last thing: the Double Balloon Endoscopy *sigh* The only place in Michigan that does them is U of M or Henry Ford Hospital in Detroit. Given the care my elderly friend DIDN'T receive whilst admitted to HFH, AND what poor care she DID receive whilst there - FERGGEDIT! And having someone other than my gastro do a scope??? Gonna have to chew on THAT one long and hard. *sigh* REAL long and hard. I so want to see what is REALLY going on in my gut for myself .... but to have someone else do a scope ???? I dunno 'bout that one.

Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.

Post Edited (CrohnieToo) : 1/10/2008 3:08:58 PM (GMT-7)

Veteran Member

Date Joined Mar 2006
Total Posts : 1169
   Posted 1/10/2008 3:42 PM (GMT -7)   
Well the pill takes picstures of the entire upper and middle GI tracts, including the whole small bowel. And just because you are currently free of major symptoms doesnot mean there would not be some active inflammation to see somewhere in the small intestine. I had my most recent scope just before Christmas -- have relatively mild disease, but I will have mini-flares now and then for a day or two, once or twice a month. I've always had evident disease -- inflammation and a few ulcers -- in the cecum, with visible inflammation in the small section fo the terminal ileum that can be visualized by scope. So we got into the TI (I do scopes with no meds) and my GI kept looking around and said "I can't find any active disease here!" He finally localized a very small ulcer adjacent to the ileocecal valve and biospied it. But I still have alow level of inflammation somewhere -- roughly 12 out fo 14 days I have normal stools, but will pop a mini-flare every couple of weeks. I'm convinced that there's a pocket or two of continuous inflammation somewhere in the small bowel. Haven't had the pill . . . no real need given my level of |Crohn's activity -- but it's pretty clear to me that even absent steady symptoms, something is still going on deep inside most of us. So I think the pill cam is worth it for you . . . if only to establish a baseline for future comparison. Just my nickel's worth./

Veteran Member

Date Joined May 2003
Total Posts : 9448
   Posted 1/10/2008 4:14 PM (GMT -7)   
Thanks, Mike. I'll most likely go thru w/it now whilst things are quiet - just "cause I know it can be done here now, 'cause the curiosity is always so utmost in my mind when something is going on and 'cause I have no intention of having to undergo another resection because we got complacent and under-treated minor activity.

D*mn tho, I WISH my gastro did the double balloon endoscopy!!! THAT we can video the monitor and get the entire small intestine on CD (love these new video cams that can "do" CD/DVD and flash drive!!).
By the way, I do most all my scopes w/o sedation too, at my request, but we do use some Demerol or Alfentenyl for analgesia for the two areas that can get uncomfortable for me - I have quite a redundant transverse colon and the TI at the ICV is somewhat "deformed" as Mayo Clinic phrased it. I did have one scope w/diprivan (propofol) which went great - if you don't mind being "sedated" (I do) - and my very first scope they used Versed and I reacted, flipped out, got agitated and then downright hostile as my gastro phrased it. That first scope was incomplete because of the "hostility". Hubby said he could hear me way down in the family waiting room threatening to kill anyone who came anywhere near me! He said it took 3 nurses to hold me down whilst my gastro w/drew the scope. (I was too embarrassed to verify that last w/my gastro but the dictated report did say "incomplete procedure" due to patient getting "agitated" and "hostile" in response to Versed).

Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.

Post Edited (CrohnieToo) : 1/10/2008 4:29:02 PM (GMT-7)

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