Jewish World Review Feb. 12, 2003 / 10 Adar I, 5763

With a tiny camera, doctors get the inside story on abdominal pain

By Ed Susman | If you have a pain in your belly or something else that is causing you abdominal problems, it would be nice if you could just swallow a little pill that would take pictures inside your intestines so doctors could see what was going on.

While that might brings flashbacks to science fiction stories and movies from years ago, researchers say they have developed a tiny pill that holds a camera, battery and transmitter. The camera-in-a-pill can be swallowed by a patient and then the device transmits images for eight hours.

Doctors said the ``gutcam,'' ``pillcam,'' appears to be successful in depicting bleeding abnormalities in the intestines, ulcers and even tumors -- and, in some cases, does a better job of detecting these abnormalities than either of the current commonly used diagnostic tests, computerized tomography (CT) scans or barium X-ray studies.

Dr. Amy Hara, a radiologist from the Mayo Clinic in Scottsdale, Ariz., reported on the first 52 patients who underwent testing with camera endoscopy at a recent scientific session of the Radiological Society of North America.

She said camera endoscopy detected three tumors, eight ulcers and 11 vascular abnormalities missed by barium enema. The tiny camera also found five blood-vessel malformations, four ulcers and two tumors missed by CT scans.

The ability to identify the blood-vessel problem known as an arterial vascular malformation, or AVM, is especially important because ``we have never had a way to identify this before bleeding occurred,'' said Hara. By identifying this potential problem early, she explained, gastroenterologists can do surgical repairs to prevent intestinal bleeding.

Dr. Hedvig Hricak, chairman of the department of radiology at Memorial Sloan-Kettering Cancer Center in New York, called the camera endoscopy devices and system a major breakthrough. ``Finally something for the small bowel. Until now we had no effective way to examine this area,'' she said. ``Until now, we could only image either the beginning or the end of the intestine. This is the first chance to view the entire length.'' Hricak was not involved in the Mayo study.

``The bottom line is that the camera did better than either barium or CT,'' Hara said, but she cautioned that as good as it is, the camera is not perfect. In fact, camera endoscopy has a number of problems and limitations. For example, it is only effective if the person has an empty intestine. Patients need to fast for eight hours before swallowing the camera pill, and in some patients, that isn't long enough to empty the intestine, she said.

Another shortcoming is the lack of control over camera angles and direction. ``The camera is literally tumbling through the intestine so we only get pictures of what it is pointed at,'' Hara said. ``As our camera tumbles through the intestine, you don't know exactly where the mass is located.''

CT, by contract, provides a very good global view of the body, and specialized parameters can be employed to localize lesions, she said.

The greatest problem, however, is pinpointing the image shown by the camera. For eight hours after the patient swallows the camera, it sends out digital images at the rate of two pictures a second to external sensors placed on the patient's chest and abdomen. Those sensors send the images to a recorder that the patient carries like a tummy pack. The recorder images are downloaded to a computer so that the doctor can ``read'' the images.

The image has a time line so the doctor knows when it enters the stomach, leaves the stomach and enters the intestine. The doctor uses these time coordinates to estimate the progress of the camera and the location of the images. Not an easy task, said Hara, because the intestine is actually 23 feet long and folded in on itself.

One way to pinpoint location is to use CT images to help localize the image, Hara said. As the endoscopy camera technology evolves, it probably will be used regularly in conjunction with CT scans.

Overall, 42 patients underwent a barium study and camera endoscopy. The camera found abnormalities in 23 o

f those patients; the barium study found just one patient with an abnormality. The doctors gave 23 patients the camera endoscopy and a CT scan. The camera located 14 abnormalities. CT found five problems in the patients.

The procedure costs about $2,500, although only $500 of that goes for the one-time-use camera. The test is covered by Medicare and other insurers, Hara said.

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