You can exercise before a colonoscopy

Colonoscopy with a capsule: a self-experiment

The thought of a colonoscopy with an endoscope scares many people. An alternative is the so-called colon capsule: a mini camera that you can swallow. It naturally traverses the gastrointestinal tract, sending hundreds of thousands of photos to a recorder on its way. The doctor then evaluates the images and looks for preliminary stages of colon cancer. A self-experiment.

The thought of a colonoscopy with an endoscope scares many people. An alternative is the so-called colon capsule: a mini camera that you can swallow. It naturally traverses the gastrointestinal tract, sending hundreds of thousands of photos to a recorder on its way. The doctor then evaluates the images and looks for preliminary stages of colon cancer. A self-experiment.

What is about to make its way through my bowels is very similar to a spaceship, albeit one in miniature format. The three-centimeter-long capsule, which can be comfortably held between thumb and forefinger, is packed full of technology: a camera at the front and rear, each surrounded by four bright, violently flashing LEDs, a battery, a mini transmitter ... This thing, What doctors call a colon capsule will shoot hundreds of thousands of photos of the stomach, small and large intestines on its journey through me and send them to the outside world. I won't feel any of it ...

It's seven o'clock in the morning. I have to wait a little longer before I can swallow the capsule in Jan Peter Grüber and Klaus Peter Kolbe's gastroenterology practice at Schlachtensee, which is supposed to transmit a colonoscopy naturally. Unlike the endoscope usually used for this purpose, which a doctor pushes in the opposite direction into the digestive tract. Both examinations serve the early detection of colon cancer and its precursors. Since the malignant tumor can be cured particularly well in the early stages, the colonoscopy is considered the gold standard in cancer prevention. You have the best chances if the doctor discovers an ulcer in its benign preforms and removes it immediately: growths called polyps in the intestinal wall.

But despite the clear successes of this medical screening colonoscopy, too few people in the main target group make use of it. Between the ages of 55 and 74, the figure is only 15 percent of men and 17 percent of women over a five-year period. Many are afraid of the endoscope, the 1.50-meter-long flexible tube that the doctor uses to maneuver through the digestive system. Others have such a tortuous bowel that you couldn't get an endoscope through all the way.

The colon capsule was invented for these patients. It is swallowed and goes through the gastrointestinal tract. The strong light source, whose flashes could illuminate a medium-sized room well, is necessary so that the images show details that are informative for the doctor. After all, the capsule crosses regions of the body where the sun never shines.

Capsule versus endoscope: fewer side effects but also fewer possibilities

The technology itself may speak clearly for the capsule and against the endoscope. For example, there are the risks and side effects. With conventional endoscopy, these can be considerable, even if they occur rarely. These include injuries to the intestinal wall, bleeding or undesirable side effects of the drugs with which one is immobilized for the examination. According to the Berlin colonoscopy study (Becop), complications occur in one in 200 endoscopic colonoscopies. This is different with the capsule: no drug sedation is required for its use. Injuries are almost impossible. Rather, the potential complications are that the capsule takes more than a few hours to pass. In individual cases, a few days could pass, says the doctor Klaus Peter Kolbe, who oversees the capsule mirroring and will later evaluate the recordings, in the patient information consultation.

However, the use of the capsule for colorectal cancer screening is controversial among experts. The Berlin gastroenterologist Andreas Schröder made a conscious decision not to use the capsule for colon examinations. "The accuracy in recognizing polyps is currently still lower than with endoscopes," says Schröder, who is also chairman of the association of gastroenterological internists in Berlin. Studies have shown that. The anatomy of the large intestine does not allow the capsule to evenly scan the entire organ, says Schröder, who himself only uses the endoscope for preventive colonoscopy in the large intestine. "The capsule moves sometimes faster, sometimes slower through the intestine, quickly falling down in the descending branch of the colon." Polyps less than one centimeter in size are difficult to find - but this also applies to colonoscopies with an endoscope or computer tomograph. But an endoscope can be pushed back and forth to take a closer look. In addition, you can also rinse with an endoscope if an area of ​​the intestine has not been cleaned sufficiently to be able to reliably detect changes.

And finally: if the capsule finds something that has to be removed or if tissue samples have to be taken to clarify a suspected tumor, the endoscope comes into play again - with all the inconvenience. But that doesn't put the advantages of the capsule into perspective, says Kolbe. "After all, the vast majority of screening colonoscopies are performed on healthy people, for whom the capsule spares them the risks of using an endoscope."

However, preparing for the capsule examination is no more pleasant than a conventional colonoscopy. It may even be necessary to do a little more, i.e. drink more fluids. Because so that the doctor can see something, the intestines must be clean. And for this it is necessary to pour large amounts of laxative and water into yourself. What is invisible to the capsule lens is also invisible to the doctor, who then evaluates the images.

For the patient, this means having to fast the day before the examination, even if clear liquids such as tea or broth are still allowed. I had to take a total of two liters of dissolved laxative plus two liters of water. The laxative tastes awful despite the added lemon aroma - imagine the taste of a lemon candy rolled in salt! But there is no other way. Because the salts dissolved in the liquid not only have a laxative effect, they also prevent the intestinal wall from doing what it normally does: absorb the liquid. This allows the digestive tube to be properly flushed through - and the capsule has something to swim in.

But before the journey into the self can begin, Klaus Peter Kolbe's practice assistants put on a belt to which, among other things, the recorder for the images is attached. As it travels through the body, the capsule transmits the images directly to the recording device.

After I've swallowed the capsule and the first images of the esophagus and stomach land on the recorder, another glass of laxative follows, followed by four glasses of water. The taste becomes more hideous every time ... That is of course a subjective impression, others will certainly cope better with the aroma that takes getting used to.

This is necessary to get the innards properly moving and to move the capsule quickly into the small intestine. Now it's time to go for an hour's walk. So that the peristalsis of the intestine gets going - and with it the capsule too. Fortunately, Kolbe's practice is right on the Schlachtensee, which you can hike along. That brings some distraction from the growling stomach and the slight feeling of sickness that you get when you haven't come from the toilet for more or less two days.

Almost 45 minutes later: The first beep of the recorder, which not only receives the images, but also follows the path of the capsule with a kind of navigation software, indicates that the device is now in the small intestine. I have to go back to the office. The doctor checks the image quality again. “Looks good,” says Kolbe. I suppose he doesn't mean my intestines, but the position the capsule has reached.

Now you have to wait until nature takes its course. You can do everything without the technical equipment being in the way. So do your office job too. Anything between two and six hours before the capsule leaves the body is normal. “Two hours is the record for us,” says Klaus Peter Kolbe. I don't break the record either - or better said my intestinal muscles. But with just under three and a half hours, it's over pretty quickly.

A walk gets your bowels and capsules moving

Now you have to wait until nature takes its course. You can do anything without the technical equipment. So do your office job too. Anything between two and six hours before the capsule leaves the body is normal. “Two hours is the record for us,” says Klaus Peter Kolbe. I don't break the record either - or better said my intestinal muscles. But with just under three and a half hours, it's over pretty quickly for me. For the doctor, this is where the real work begins. He now has to evaluate the pictures. There are automatic tools that support the medical professional in evaluating the 400,000 or so individual images that the capsule has sent on its way. And the experienced gastroenterologist also knows in which sections of the digestive organ to take a closer look and where a more superficial look is sufficient. Nevertheless, Kolbe spent up to an hour evaluating the video material from a single capsule in order to be able to write his findings. And if the intestine is not optimally cleaned after all - which is shown by the fact that the liquid in which the capsule drifts through the intestine is cloudy - then the doctor has to laboriously take a closer look, image by image, in order to avoid even smaller polyps overlooked.

Despite all the preparations, the intestines of one in ten patients are so inadequately cleaned that the result of the examination is not 100 percent certain, says Kolbe. It is also difficult to avoid, because people are not identical cars, but so different that the cleaning procedure that is repeated over and over again is not sufficiently effective for some. It's a compromise. In order to be able to examine these ten percent as well as possible, one would have to treat the remaining ninety percent with even more laxatives, although that is not necessary at all. And the preparation for the examination is one of the main reasons that so many people still forego a preventive colonoscopy. If the doctor makes it even more uncomfortable, acceptance would probably be even lower.

I sit next to the monitor on which Klaus Peter Kolbe evaluates my film. So this is how I look inside. The damp, shimmering parchment-colored walls are marbled with innumerable fine red blood vessels. Muscle rings run through the tissue at regular intervals, somewhat reminiscent of the view up a triangular stairwell. These rings ensure the peristalsis of the intestine, i.e. the involuntary movements with which the chyme is transported through the digestive organ.

“No findings,” says Kolbe. I'm relieved. Everything OK.

The capsule did its job. Now it is useless and also electrically dead after a good 24 hours, because then the battery is empty and the flashing LEDs go out. With no lighting effects, the capsule looks a lot less impressive than a small piece of plastic.

But even so, many patients keep the now useless piece of high-tech as a memory. Very few people simply flush the capsule through the toilet. It would also be an expensive piece of equipment that rushed into the sewer system: the capsule endoscopy costs around 1150 euros in total - the capsule alone adds 700 euros, the rest goes to the doctor.

As a rule, the patients pay for it themselves. There are, however, many examples in which private health insurances have covered the costs on request, says Kolbe. The statutory health insurances have so far only paid for this examination in individual cases, like the AOK Bavaria in a model project. But usually the cash registers still rely on the endoscope.

The technology for screening colonoscopies has been in use since 2006. This means that after the around 1.7 million capsules used worldwide so far, a lot of experience has accumulated. And there are more and more. “A year ago I had an average capsule endoscopy per month, now it's already a week,” says Kolbe.

 

Ingo Bach






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