Once swallowed, a tiny camera tours the digestive tract and allows doctors to find problems within patients

By CLAIRE HUGHES, Staff writer
First published: Monday, January 27, 2003

ALBANY -- For the last couple of years, Joseph Semione had been bleeding internally. The 71-year-old Gloversville resident was anemic and needed several blood transfusions.

Doctors didn't know why.

High-tech examinations of Semione's colon, esophagus and stomach showed nothing. Then Dr. Edward S. Orris suggested a novel method of looking for the problem.

All Semione had to do was swallow a big pill -- with a camera inside it.

Eight hours later, 57,000 images of Semione's small intestine were ready for downloading into a computer. When Orris looked them over, he found Semione's problem: a cancerous tumor. Earlier this month, a surgeon at St. Peter's Hospital removed it.

The pill is referred to unofficially as the "gutcam" and officially as the M2A (for "mouth to anus"). The procedure is "capsule endoscopy." Orris' practice, Albany Gastroenterology Associates, is the first to offer it locally, and Semione is one of just two local patients to try it.

It is a miniature, disposable, color video system that apparently is painless to take. It travels through the digestive tract taking two pictures a second in a trip that doctors and the pill's manufacturer liken to the 1966 science-fiction film "Fantastic Voyage," in which miniaturized scientists battle their way through a human body.

Semione said the most unusual part of the procedure was swallowing the 11-by-26-millimeter pill, as big as a .38-caliber bullet or a wide cigarette filter. It wasn't the size that got Semione, though, but the blinking lights.

"It was funny to see it, because they have to activate it, and it's flashing when it goes into your mouth," Semione said.

The camera transmits images of the digestive tract through a digital recorder in a belt strapped around the patient's hips. Sensors are attached to the patient's abdomen, and suspenders help support the weight of the recorder and a battery pack. Patricia Nevinger, a nurse at Albany Gastroenterology, said the entire getup weighs about 3 pounds; Semione said it felt no heavier than a tool belt holding a few items.

With the system hooked up, Semione walked around Crossgates Mall, where, to keep anything from getting in the camera's way, he had to wait two hours to drink and four hours to eat. He wore the contraption for eight hours. The pill itself passed easily through his digestive system (no need to retrieve it).

"It really wasn't bothersome, not bad at all," Semione said.

Semione seemed like the perfect patient for capsule endoscopy, Orris said. Other forms of diagnosis had proven unsuccessful, and Semione was willing and healthy enough to undergo surgery if the M2A detected something.

Capsule endoscopy is most useful in finding problems in the small intestine, a coiled organ up to 20 feet long that is virtually impossible to reach through other types of medical detection, Orris said. The organ's small diameter also keeps the camera fairly stable so it can capture detailed images of the intestine walls.

"You just can't see well in the stomach and colon because of the size," Orris said. He picked the pill up in his thumb and forefinger. "This thing will tumble."

Symptoms and illnesses that might benefit from diagnosing or monitoring through the M2A include internal bleeding, abdominal pain, recurrent diarrhea, Crohn's disease, ciliac disease or small intestinal polyps.

Rather than replace other diagnosis techniques, Orris said, the procedure will probably always be used after colonoscopy and endoscopy of the upper gastrointestinal tract, in part because of its cost. The pill costs $450, and Albany Gastroenterology charges at least $1,000 for each procedure, said Karen Brimmer, the practice's administrator. Albany Gastroenterology invested about $30,000 for the belt, sensors and computer software to record and download images, Orris said. It takes up to two hours for a doctor to scan the images once they're downloaded.

By comparison, a routine endoscopy of the upper GI tract usually costs about $150, Orris said.

"It's important, but it's for a small subset of patients," Orris said. "The majority will have problems explained by routine evaluation."

The U.S. Food and Drug Administration approved the system in August 2001. Its manufacturer, Given Imaging of Israel, recently improved its method of estimating the location in the small intestine where an image was taken, Orris said.

More and more insurance carriers are beginning to pay for the procedure, too, Orris said.

Tumors, ulcers and bleeding vessels are the most common problems the pill can find, Orris said.

In studies, the pill lodged in the digestive tracts of about 1 percent of people who took it properly, according to the Given Imaging Web site. That's another reason a patient must be a good candidate for surgery before taking the pill, Orris said -- if the M2A gets stuck, it must be surgically removed.

Still, Orris predicted the M2A will become an increasingly important tool for finding the cause of gastrointestinal illness when other methods have failed.

"It's fun -- it's definitely something a little bit different," he said of the new technique. "And it's also nice to have something to offer these people who are frustrated."