In modern medicine one of the most inaccessible for examination parts of gastrointestinal tract(GIT) is a small intestine. The length of a small intestine is individual and on average is about 3-5 m. Until recently doctors could visualize only 30-40 cm of the upper small intestine(duodenum) and 10-20 cm of the lower small intestine (ileum). X-Ray and other non-invasive methods of examination can determine only gross pathology. In this way, until recently the most part of a small intestine has been remained unscreened and has been a mystery for the doctor. The newest method of video capsule endoscopy is called to solve this problem.
Capsule endoscopy- is afundamentally new method of examination of a small intestine with the help of an endoscopic capsule- a tiny capsule equipped with a camera.
In frame of invitation of the management of MC Nairi in September 29th of 2016 the representative of technology manufacturer Jinshan(China) ChjanTzuan in a conference hall of the clinic has presented thenew method of a capsule endoscopy for attention of endoscopists and gastroenterologists. She mentioned that this method is holding the leading place in the field of GIT examination.
The main activity of the Jinshan technology company is a modern high-tech development, scientific researches, sale and service of the digital medical equipment. Jinshan is the only company in China engaged in the production of endoscopic capsules, and the only company in the world engaged in the production of managed endoscopic capsules.
Endoscopic equipment OMOM represents a new, painless diagnostic instrument, developed by Jinshan company. The systems of OMOM capsule endoscopy areworking successfully in the clinics of China, Russia, Spain, England, German, India and other countries of the world
Today Armenia will stand among the countries using endoscopic capsules for more accurate diagnosis of GI tract diseases, particularly, of a small intestine.
Examination of gastrointestinal tract is carried out by oral administration of the capsule. Disadvantages of traditional forms of examination are eliminated (pain, discomfort, the inability of examination of elderly and severepatients, etc.)
Capsule endoscopy - is a revolution in the digestive system examination. The capsule endoscopy equipment is a wireless device, including micro camera, digital processing device, wireless transmission system, light source, etc. After swallowing the capsule, the image of GI tract is transmitted to exosomatic receiver. It gives the color image of the entire small intestine in very good quality, which is paramount important for diagnostics of diseases, in particular such as Crohn`s disease, intestinal bleeding of an unknown etiology and localization. The capsule takes thousands of pictures in the digestive tract and transmits digital signals through a wireless connection into an exosomatic memory. The doctor performs diagnosis based on the received images.
The advantages of the equipmentis a small size and weight, the possibility of applying without surgical or invasive intervention, absence of pain, the prevention of spread of infection while maintaining the usual activity.
Indications for capsule endoscopy OMOM:
• Obscure gastrointestinal (GI)bleeding of an unexplained etiology and localization
• Chronic iron deficiency anemia
• Suspicion of Crohn`s disease
• Suspicion of a small bowel tumor
• Monitoring the development of intestinal polyposis
• Suspicion of malabsorption diseases(for example hilum)
• Dysfunction of intestinal absorption
• Peristaltic violation and Celiac`sdisease, which are associated with irritation of the intestinal epithelium
• Examination of diseases of mucous membrane of the small intestine
• Intestinal diseases of an unknown etiology
• Medical examination of the digestive tract
Contraindications:
• Violation of the swallowing function (dysphagia)
• Obstruction or the narrowing of the GI tract on different level
• Acute inflammation of the bowel, colitis
• Acute anemia
• The presence of any implants , using power supply , including pacemaker
• Pregnancy For qualitative examination careful bowel preparation is required.
The capsule passes gastrointestinal tract(GI) and the doctors don`t have any possibility to clean the intestine during observation or observe the area of interest from the requested sides. That is why the quality of bowel preparation directly affects the quality of diagnostics. Preliminarily the patient is performed a standard bowel preparation for endoscopic examination.
To undergo the capsule endoscopy examination, the patient is worn a small device receiving a signal from the capsule. The capsule is activated by a special device, then it is swallowed by a small amount of water. The process of swallowing doesn`t differ from the medication. After that the doctor checks the functionality of the capsule.
After ingesting the capsule moves towards: esophagus – stomach – duodenum – small bowel – ileum – colon – rectum, while at the same time taking thousands of pictures of the intestine. The digital signals are transmitted to a data recorder. All images are saved in the recorder automatically. All data are imported to computer with a Preset Viewer. Data transcription takes a few hours, after which the patient is given a protocol with description, conclusion and photo images, which have a diagnostic value. The time of examination is from 8 to 15 hours. The capsule is excreted from the body in a natural way with the feces.
The patient XX, 1944 y/b, has been admitted to MC Nairiin September 28th of 2016 with complaints of chronic diarrhea during the last three, four years. According to studies: gastroscopy, colonoscopy, urine and blood tests, no pathology was detected explaining the complaints of the patient. In history the patient was suffering from diabetes and hypertensive disease. In September 30th the patient was prepared for video capsule endoscopy. Two days before examination the patient kept a special diet aimed to maximal purgation. One day before the bowel was prepared(additionally cleaned out).
In the morning of September 30th 40 minutes before the examination the patient drank 30 ml of diluted Simethicone. After the appropriate preparation of the equipment, and connection of the recorder to a sensor, the patient swallowed the capsule with a small amount of water. The video capsule transit(passage through GI tract) took 11 hours and 52 minutes. On the next morning the information from the data recorder was transmitted to computer and with the help of a special licensed program was processed.
Conclusion of video capsule endoscopy examination: Erosive antral gastritis, duodenitis, terminal ileitis, superficial colitis.
| Erosive antral gastritis |  |
| Expressed duodenitis |  |
| Small intestine(norma) |  |
| Flattened mucosa |  |
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| Участок гиперемии |  |
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| Выраженный терминальный илеит |  |
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| Илецекальный переход |  |
The beginning of the cooperation with a Jinshancompany, which occupies a leading position in technology of video capsule endoscopy, and implementing a new innovative technology in MC Nairi will allow to raise the medicine in Armenia on a new level, particularly, in research and diagnostics of gastrointestinal diseases.
