PillCam gives doctors a look inside

By Shirley Wang

August 5, 2005

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, Pennsylvania. "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 oesophagus.

With just a few swigs of water, the camera slides down the oesophageal tract, lights flashing from both ends of the pill, and takes 2600 images - 14 per second - for quick diagnosis while minimising 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 Centre.

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.

Several new pill-size cameras are in the works, including one that measures the function of the stomach, and ultrathin endoscopes that enter through the nose already exist.

Researchers foresee that cameras will commonly monitor parts of the body more and more in the future.

Manufactured by Given Imaging, an Israel-based company, PillCam ESO was approved by the US Food and Drug Administration eight months ago.

Unlike the endoscope, the PillCam cannot be directed to or linger on specific parts of the oesophagus. 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 US sites that conducted pilot research on the device. To date, it has used the PillCam ESO in about 100 patients, Infantolino said.

The PillCam ESO is used primarily to screen people with chronic acid-reflux disease, a condition in which the acidic liquid of the stomach backs up into the esophagus.

They are screened for Barrett's oesophagus, a pre-cancerous condition, as well as for swollen veins and bleeding in the oesophagus.

People with Barrett's are 40 times more likely to develop cancer, said Infantolino. That's one out of every 10 Barrett's patients, added Krevsky.

Doctors may opt to use the PillCam ESO as a sort of triage tool, a first-line screening to see whether patients need an endoscopy, said Infantolino. If the images show abnormalities, patients can then undergo an endoscopy to take a tissue sample.

The patient ingests the camera lying down. As the device moves down the oesophagus, 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 were no published studies of its diagnostic accuracy compared with the endoscope, Krevsky said.

Also, because the oesophagus 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 $US450 ($A600) a pop, and patients pay about $US1000 ($A1300) for one visit to the doctor for a PillCam.

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.

"We're very excited about this pill," said Parkman. "It can give us a lot of information."

So now that the pill age has apparently arrived, why swallow anything else?

