Sunday, July 31, 2011

Will Wireless Capusle Endoscopy Replace Colonoscopy?

Most of born several decades ago, recall the futuristic book Fantastic Voyage by Isaac Asimov, where a miniaturized crew traveled through a human body to cure a scientist who has a blot clot lodged in his brain. Ironically, miniaturized medical care is now upon us while books are at risk of becoming obsolete.

I hope that gastroenterologists won’t become obsolete, at least until my last kid graduates from college.

I perform an amazing diagnostic procedure called wireless capsule endoscopy (WCE), when patients swallow a camera. Once swallowed, this miniaturized camera takes its own fantastic voyage through the alimentary canal. The test is used primarily to identify sources of internal bleeding within the 20 feet of small intestine, which are beyond the reach of gastroenterologists’ conventional scopes. I have performed over 200 of these examinations, and I am still awestruck when I watch a ‘movie’ of someone’s guts. While most examinations do not reveal significant findings, I have seen dramatic lesions that were bleeding before my eyes. WCE can crack a cold medical case wide open.

Here’s a typical view of the small bowel as seen by the cruising camera.



Up to now, cameras are used only diagnostically, but this will change. In other words, at present, the camera can only visualize. Prototypes are being developed that can equip cameras to take biopsies of lesions and to stop bleeding that is encountered on their journey. Physicians will be able to guide cameras in real time to perform diagnostic and therapeutic tasks. Once perfected, a physician on the west coast could be directing a camera that is voyaging inside a Manhattanite. (Aren't most movie directors on the west coast?) Amazing stuff. Of course, this technology may also be used by other medical specialties to search out and destroy diseases in their organs of interest. It will certainly have applications beyond the medical arena.

The capsule endoscopy folks have been trying to use their technology as an alternative to colonoscopy. This is a tough sell to patients who must endure a camera prep that is more vigorous than the routine torture that we gastroenterologists require prior to a colonoscopy. In addition, since the camera is only diagnostic, if a polyp is encountered, the patient would then enjoy the delight of a future colonoscopy to remove it. The latest advance in this area is a self-propelled camera that is inserted into the rectum and then guided by remote control by a physician.

When I read about the self-propelled capsule, I realized that I have committed a grievous parental miscalculation. I have tried to restrict and discourage our kids from playing video games, which I was certain wasted time and destroyed neurons. How wrong I was. These were the precise skills that would have permitted them to become medical pioneers. I have closed off many professional options for them from my misguided zeal to encourage them to pursue silly activities, such as reading.

How will gastroenterologists react if a ‘camera colonoscopy’ becomes ready for prime time? Perhaps, a future generation of colon cameras will be able to remove or destroy polyps and other lesions? Will we willingly surrender our colonoscopes to serve the greater good? We might do what many of us do in our bedrooms and our living rooms. We may fight with other medical specialists, or even technicians, as to who gets to hold the remote control.

2 comments:

The Medical Contrarian said...

The problem will be that the amount of information that will be obtained will overwhelm our ability to interpret and act. When we can get access so easily, it will prompt us to see what we have not regularly seen and observe changes that have likely occurred commonly but we were not aware of. The questions will become, hw often do we need to look and when we look, what are the thresholds for action? Will we become obligated to respond to every incidentaloma?

Michael Kirsch, M.D. said...

@MC, regarding your oomment, Will we become obligated to respond to every incidentaloma?, isn't this reality already upon us?

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