Pillcam™ Colon Capsule Endoscopy

This leaflet will explain what PillCam™ colon capsule endoscopy is and how you should prepare for the procedure. It is important that you follow all instructions so that your procedure will work.

What should I do before my procedure?

Three to five days before your procedure

Before the procedure, you should eat a low fibre diet. This will help to keep your bowel clear and make the procedure easier.

Which foods can I eat?

• White flour products (bread, pasta, etc.)
• White rice and potatoes
• Eggs
• Oils (olive, canola, soy)
• Dairy products including butter, margarine, and mayonnaise
• Unseasoned white meat or fish
• Chocolate and sweets (without fruits or nuts)
• Tea and coffee with milk and sugar/sweeteners.

Which foods should I avoid?

• All fruits and vegetables
• Any wholegrain product
• All breakfast cereals
• Instant soup
• Red meat
• All legumes
• All varieties of nuts
• Fruit or vegetable juice.

You will need to speak to your Doctor for advice on stopping your medicine before the procedure.

You will need to stop taking any iron tablets. Iron makes everything inside your bowel black. This will make it difficult for your video endoscopist (a Doctor or Nurse specially trained to do capsule colonoscopy) to see anything.

What should I do the day before the procedure?

The day before your procedure, you should only consume clear liquids. This will keep you hydrated and keep your colon clear. It is recommended that you drink 8 glasses (240ml each) the day before your procedure.

Clear liquids you should drink include:

• Water
• Clear or fizzy sports drinks
• Tea or coffee without milk
• Ice lollies or flavoured jelly
• Apple juice or clear fruit cordial e.g. white grape
• Chewing gum or boiled sweets (boiled sweets should be dissolved slowly).

You should avoid red or purple coloured drinks and all soups/broths.

At 12 noon the day before your procedure:

Your Doctor will have given you a liquid known as PEG. This is a laxative, which will help to clear your bowel.

This is to be prepared at 12pm. Pour water into the container you have been given, putting the lid back on. Shake the container gently and when it is mixed, put it in the fridge until it is time to drink it.

Between 7 to 9pm the day before your procedure:

Drink half of the PEG solution. Try to drink 1 cup every 15 minutes. If you drink the solution more quickly, this may lead to vomiting. After 9pm, continue your clear liquid diet.

You may find it easier to drink the solution by using a straw. You can also drink other clear liquids between drinking the solution.

Prescribed tablets or medicine (if due) must not be taken within 1 hour of taking the PEG. If taken before this, your medication may be flushed out of your body by the PEG.

What should I do on the day of my procedure?

• In the morning, you should take your normal medication as your Doctor has advised

• Between 7 to 9am, drink what is left of the PEG solution. Like the previous day, try to drink 1 cup every 15 minutes to prevent vomiting.

Do not drink anything else until you are told to by the clinic staff.

• You must not eat anything before your procedure.
• So that you feel comfortable, you should wear a dark, loose-fitting shirt or T-shirt.
• You will arrive at hospital about an hour after you have finished drinking your solution. You will now be ready to swallow the PillCam™ Colon capsule. You will be fitted with a sensor belt or an array.
• If you are fitted with the sensor belt it will be worn over your clothing, around your waist. If you are fitted with the sensor array, it will be attached to your abdomen and back with sticky pads.
• The sensor belt/array connects to a data recorder, which is worn around your body. This recorder fits in a pouch with a strap around your shoulder.
• Once the PillCam™ COLON capsule is ready, swallow it with water.
• Your Doctor will advise you about which activities you can carry out while the procedure is carried out. It is likely that you can return to your normal daily activities.
• The data recorder will send various alerts and prompts as the procedure is under way. This leaflet will explain what each alert/prompt means.

It is important that the data recorder is handled with care at all times and it must be kept out of direct sunlight.

What do the alerts on the data recorder mean?

Alert 0:

As we have already given you a medication (Domperidone 20mgs) to help move the capsule into your small bowel, if you see Alert 0 when you return home, you should go for a 20 minute walk and remain active until the recorder alarms with Alert 1.

If you will need further advice, please contact the medical team that.

You must not eat or drink anything until the next alert is seen on your data recorder. You should remain active as much as possible.

Alert 1:

This alert means you should drink 30ml of the sodium phosphate booster liquid solution, mixed with water. This is a laxative and helps to move the Pillcam™ along inside your gut. Your Doctor may also tell you to mix 50ml of Gastrografin into your liquid. This is a dye that helps your Doctor to see inside your gut better.

When you have drank your solution, you should drink 1 litre of water over the next hour. This will keep you hydrated and will help with the procedure.

You are to remain active during the procedure, carrying out your normal activities where possible. You must remain awake until the procedure is finished.

Alert 2:

This alert appears about 3 hours after Alert 1. You must drink 15ml of sodium phosphate solution mixed with water. Your Doctor may also tell you to mix 50ml of Gastrografin into your liquid.

You should drink 0.5 litres of water over the next hour.

You should remain active and continue your clear liquid diet.

Alert 3:

This alert usually happens two hours after Alert 2.

When you see Alert 3 on your data reader, you must insert a 10 mg bisacodyl suppository into your rectum, giving it time to dissolve. This is a laxative and it makes your bowel to empty.

You should remain active, continue your liquid diet and wait for your next alert.

Alert 4:

After 2 hours, if you see Alert 4 on the data reader, you should eat a small meal. After this meal, you should continue to drink plenty of fluids to help the capsule move along inside your body.

You should remain active and wait for the ‘End of Procedure’ alert.

End of procedure alert:

When you see an hourglass symbol with a green tick on your data reader, it is the end of your procedure. This may happen at any time after Alert 1.

You do not need to collect the capsule after you have passed it.

What should I do when my procedure is finished?

You should sit down on a chair or bed to remove the equipment. This helps to remove it from your body without damaging the kit. If you were fitted with a sensory array, you should peel off the non-adhesive pads gently.

It is important that you do not pull the wires or remove the sensors from the sleeves.

You should return all equipment to the medical staff.

Your Doctor will get in touch with you and after looking at the images made by the PillCam™ capsule, will discuss with you the best way to continue you care.

Are there any risks involved with capsule endoscopy?

Capsule endoscopy is a very low risk, minimally invasive procedure.

The main risks include:

• Aspiration of the capsule (going down the wrong tube into the lungs).

• Retention of the capsule (it is held up somewhere in the bowel).

• Missing lesions in the bowel and an incomplete examination of the bowel due to a technical failure of the equipment.

Even if the capsule is retained in the gut, it is unlikely to lead to the capsule being damaged or causing a blockage in your gut.

Occasionally, we may need to perform additional X-rays, a limited CT scan or an endoscopy procedure to retrieve the capsule.

In the very rare event of the capsule causing an acute obstruction, surgery would be required. If the capsule has become stuck because the narrowing in your bowel is tight, then this would require surgery at some point in any case and the capsule test has simply uncovered the problem.

If the medical team think there is a risk of the capsule getting stuck, they will perform a patency capsule (a dummy run with a capsule that dissolves) before going ahead with the procedure.

Information used during the making of this leaflet

Preparing for your Procedure, Your preparation guide for PillCam™ COLON capsule endoscopy, Medtronic Information Leaflet, accessed 23.03.2021.

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