Pills Taking Pictures
UHealth is first in the world to deploy an updated endoscopy technology
By Jodie Nicotra
Illustration by Tim McDonagh
Animation by Michael DiMilo
The updated PillCam, with a camera at each end, sends images to a patch on the patient’s skin.
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n updated small bowel video capsule endoscopy technology made its world debut at UHealth – University of Miami Health System on Dec. 10. The upgrade shrinks the receiver the patient must wear from a bulky vest to a small, single-use sticker on their abdomen, offering both patient convenience and improved access to care for those who may have small-bowel pathologies.
Capsule endoscopy was first approved by the FDA for use in 2001. It involves a patient swallowing a pill-size camera, which takes pictures to be watched and interpreted by gastroenterologists. It was developed to allow evaluation of the small bowel mucosa, an area that has historically been challenging to image. While a CT (computerized tomography) scan could capture external images, prior to capsule endoscopy, the only way to view the lining of the small bowel was by invasive and challenging device-assisted enteroscopy.
“Capsule endoscopy allows us to take the 20 to 22 feet of small bowel and be able to see it relatively easily and to be able to understand if there’s a lesion,” said Jodie Barkin, M.D. ’11, an associate professor in the Miller School’s Division of Digestive Health and Liver Diseases. “That’s the first big question. And then, if there is a lesion, [it can] guide what the next steps are in terms of management.”
Imaging Small Bowel Disease
“Capsule endoscopy is the primary modality of assessment of the small bowel mucosa in patients with suspected small bowel bleeding and is the foundation of our clinical and endoscopic approach,” Dr. Barkin said. “For patients with Crohn’s disease, we use capsule endoscopy to assess the severity of disease, involvement and response to therapy. If we see inflammation or ulcers, that would guide therapies. Then one way to monitor disease activity or response to therapy in the small bowel is with capsule endoscopy.”
Less commonly, capsule endoscopy is used to image the small bowel for patients with hereditary polyposis syndrome, to screen patients who may be at increased risk of small bowel cancers and to assess patients with refractory celiac disease.
Better Images in a Much Smaller Package
Capsule endoscopy has undergone several major improvements since its initial release. For instance, the cameras themselves now have higher definition, better resolution and faster frame rates for imaging the small bowel.
“If you think about what TVs or computer monitors were like in 2001, they were great at that point, but now we’d see the pictures as grainy compared to today’s ultra-high-definition screens,” Dr. Barkin said.
But the biggest improvement in the newest capsule endoscopy product, Medtronic’s PillCam SB 3 capsule endoscopy system, is the receiver. Known as the PillCam Genius Link Device, it is the part of the technology worn by the patient to capture the images the camera takes.
When the first version of capsule endoscopy debuted in 2001, patients wore a belt and a large sensor vest, which captured information from electrodes pasted on the patient’s abdomen. “It looked kind of like a cross between a tactical vest and an EKG,” Dr. Barkin said. “Patients had to carry this big, bulky heavy equipment around all day. You couldn’t do anything else because it didn’t fit under your clothes. It would have been challenging to go to work with the original sensor vest on. And while technological improvements to the belt and receiver have been made over the years, they still remain cumbersome to patients. They also have the potential to lose contact with patient movements, which leads to potential skip areas in the created video.”
The new device condenses the bulky equipment of the old receiver into a sticker worn on the patient’s abdomen under their clothing. Since there’s no danger of the sticker losing contact with the skin, the receiver is less disruptive to patients’ everyday lives. At the end of the study, patients pull off the sticker and return it to their doctor for image downloading and video creation.
Improved Patient Access
For Dr. Barkin, this much smaller receive means not only convenience for patients, but the chance to treat more individuals. With the old equipment, the endoscopy unit would need to wait for patients to return the receiver vest, then recharge it and issue it to a new patient. “With the new device technology, we can accommodate as many patients as we need to on a specific day because the equipment is single-use,” Dr. Barkin said. “We now no longer have to worry about having to cancel outpatients who need capsule endoscopy if we have an inpatient who needs an urgent procedure or if a receiver is returned late. It’s a huge leap forward for us as a practice and a health system and it directly impacts patient care.”
Dr. Barkin anticipates eventually being able to deploy the new system at UM’s satellite endoscopic facilities. “Right now, we only offer capsule endoscopy at UHealth Tower and therefore can’t pair capsule endoscopy procedures with other procedures such as upper endoscopy or colonoscopy that may be scheduled at the same time if the patient is not having the procedure done at the Tower,” he said. “For patients who may have mobility issues — not only getting downtown but also returning the device — it’s challenging. But eventually we’ll be able to expand to our other endoscopic facilities. Ultimately, this will allow us to increase the points of care in our health system, benefitting the patients we serve.”
UHealth, because it partnered with Medtronic in the device’s development, was the first health care provider in the world to use this new capsule endoscopy receiver.
“We are very proud to be the first system to use this updated technology,” Dr. Barkin said. “But most of all, we’re pleased to be able to offer it to our patients.” 
