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Small bowel capsule endoscopy

FREDERICK GASTROENTEROLOGY ASSOCIATES

SMALL BOWEL CAPSULE ENDOSCOPY

PATIENT INSTRUCTIONS

Please report to our Frederick office on _________________________at 8:00/8:15 AM
Your physician has determined that as part of your medical evaluation you should
undergo an examination known as a small bowel capsule endoscopy. This procedure
involves ingesting a small PillCam capsule which will pass naturally through your
digestive system while taking pictures of your small intestine. The images are transmitted
to the Sensor Belt or Sensor Array which is placed on or around your abdomen. This is
attached to a DataRecorder which saves all the images and is worn on a belt placed over
your shoulder or around your waistline. After 8 hours, you will return to your
physicians’ office where the equipment will be removed for processing. The PillCam is
disposable and will be excreted naturally in your bowel movement. In the rare case that
it is not excreted naturally, it may need to be removed endoscopically or surgically. DO
NOT TAKE ANY IRON PRODUCTS, ANTACIDS CARAFATE, QUESTRAN,
BENEFIBER, CITRUCEL, METAMUCIL, PEPTO BISMOL, OR KAOPECTATE
FOR ONE WEEK PRIOR TO YOUR SMALL BOWEL VIDEO
. **DO NOT USE
ANY BODY LOTIONS OR CREAMS ON TEST DAY!

** Please follow the instructions below to ensure we obtain the most accurate
information from this test:
THE DAY BEFORE CAPSULE ENDOSCOPY:

1. After lunch (no later than 1:00 p.m.) on the day before the SB capsule
Endoscopy, start the liquid diet attached to these instructions. DO NOT eat or
drink anything after 10 PM except for taking any necessary medications with a
small sip of water.

2. DO NOT smoke for 24 hours prior to this test.
THE DAY OF YOUR CAPSULE ENDOSCOPY:
1. DO NOT take any medications for 2 hours before coming into the office (from
6:00 AM on the day of your test). **Women: Please avoid lipstick or lip gloss. 2. **Arrive at our office at scheduled time dressed in 2-piece, natural fiber, loose
fitting clothing. **Cotton T-shirt or shirt is preferable**
3. You will be checked into the office and the medical assistant will ask you to sign an informed consent form and waivers for the equipment if you have not already signed this paperwork. 4. The Sensor Belt will be placed around your waistline. (SensorArray pads may be applied to your abdomen) and will be connected to the DataRecorder which you will wear in a belt over your shoulder or around your waistline. After that, you will be instructed to swallow the PillCam. AFTER SWALLOWING THE CAPSULE:
1. After swallowing the PillCam capsule, DO NOT EAT OR DRINK ANYTHING
FOR 2 HOURS. After 4 hours, you may have a light snack. CONTACT YOUR
PHYSICIAN IMMEDIATELY
if you suffer from any abdominal pain, nausea, or
vomiting during the capsule endoscopy.

2. After swallowing the capsule, and until it is excreted, you should not be near any
source of powerful electromagnetic fields such as an MRI machine or amateur
ham radio.
(Images can be lost due to radio interference and the test would have
to be repeated.)

3. The small bowel capsule endoscopy is considered complete after 8 hours. DO
NOT disconnect or remove any of the equipment at any time during this period.
The DataRecorder is a small computer and must be handled with the utmost care
and protection. Avoid sudden movement and banging of the DataRecorder.

4. DO NOT disconnect any of the equipment or remove the belt at any time during
the 8 hour testing period. Please record any eating, drinking, activity or unusual sensations during the test on the Event Form on the other side of this page. 5. PLEASE CHECK THE BLINKING BLUE LIGHT on the top of the
DataRecorder every 15 minutes to make sure it is blinking twice per second. If it is not blinking or changes color, please note the time and contact your physicians’ office immediately. 6. Avoid any strenuous activity especially if it involves sweating and do not bend over or stoop during the capsule endoscopy. Also, please do not nap during the testing period. AFTER COMPLETING THE SMALL BOWEL CAPSULE ENDOSCOPY:
1. After the 8 hours is completed, please return to your physicians’ office at 4:15
PM.
2. Please remember that this equipment is very sensitive and it should not be exposed to shock, direct sunlight, or vibration. 3. If you did not verify excretion of the capsule and develop any abdominal pain, nausea, vomiting, contact your physician immediately. You may need an x-ray to verify that the capsule has been excreted from your body. You must not undergo any MRI while the capsule is still in your body and this can result in serious damage to your intestinal tract or abdominal cavity. An x-ray must be performed to document that the capsule is not present before any MRI or other magnetic procedure is done. SB CAPSULE ENDOSCOPY EVENT FORM
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**IFANY PROBLEMS, CALL 301-695-6800 & ASK FOR A MEDICAL ASSISTANT

Source: http://www.fgamd.com/forms/smallbowel.pdf

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