Déjà vu

Here we go again!

An endoscopy capsule is stuck in my gut. Again. In 2004, I had two capsules entrapped in my small intestine, and lost 50 cm of bowel in the surgery to remove them. 

So why did I do it again? Excellent question! One I keep asking myself. 

example of endoscopy pictures

I swallowed it to help Dr. Cutler, my gastroenterologist, find out why I so frequently have trouble with partial, and sometimes total, small bowel obstructions. The idea was that it was the best method to see via thousands of full-color, digital photographs the camera inside the capsule would take twice every second as it passed through my small intestine. We discussed other studies, but he felt that the capsule was the best choice for finding out what keeps happening.

Radio-opaque, dissolvable capsule
for patency verification

He tried to get approval from my insurance (Anthem Blue Cross) for me to first swallow a same-size, but dissolvable capsule to make sure it could get all the way through without getting stuck. The dissolvable capsule is visible on X-ray, but dissolves 30 hours after being swallowed. So if it did get stuck, we'd know I shouldn't swallow the other one made of plastic and metal. And, we'd see where it got stuck, which might offer some insight into where my small intestine is narrow enough to cause an obstruction when it gets inflamed. It sounded good to me. 

Someone at the gastrointestinal lab at at the University of Utah gave me one of the dissolvable capsules in the summer when the U was trying (unsuccessfully) to obtain authorization from Blue Cross for the same test. A vendor gave them some free samples to try, and they wanted to be sure I had one before they were gone, so I took it home and put it in my fridge. I would swallow it two days before the day I was scheduled to swallow the capsule containing the camera, then get an X-ray the next day to see if it was still there. 

The Blue Cross physician reviewers that Dr. Cutler talked with while seeking authorization for the procedure had never heard of such a thing. But after months of trying, Dr. Cutler finally found a cooperative physician who promised approval if I would undergo an entroclysis or a small-bowel follow-through X-ray first to make sure there was no place the endoscopy capsule could get stuck on the way through. So I chose the less expensive of the two -- the small-bowel follow through. 

Illustration of a normal
small intestine. Not mine.

Results said my bowel was perfectly patent and normal, with no known strictures or visible inflammation. So Dr. Cutler assured me that he was confident I would have no trouble passing the capsule all the way through without it getting stuck.

Two nights before I was scheduled for the capsule endoscopy test, I decided that I should swallow the dissolvable capsule even if Dr. Cutler didn't think I needed to. If it got stuck, I figured, I'd have pain like I usually have with small bowel obstructions, and I'd know there was a problem. My husband, David reminded me that the first time an endoscopy capsule was lodged in my gut, I didn't know it was there until the second capsule photographed it, as Dr. Kathryn Peterson at the University of Utah (who was a resident at the time, reading my study) said "just hanging out in there."

I swallowed the thing at 7:30 p.m. and waited for any indication of problems. I had my usually occasional twinges and lots of diarrhea, but no obvious, unrelenting, painful distention, no vomiting, no obvious sighs of obstruction. The next afternoon, I thought I'd better come clean and tell Dr. Cutler what I'd done. I thought it would be wise to have an X-ray to be sure there was no problem. So I called and left a message telling that I'd swallowed the radio-opaque, dissolving capsule, and suggested that maybe I should get an X-ray. After relaying the message to Dr. Cutler, his medical assistant (MA) called me back and said that there was no need for an X-ray because Dr. Cutler felt confident there would be no problem, based on the results of the small-bowel follow-through. 

2 endoscopy capsules and
1 dissolvable, radio-opaque capsule

So, at 8 am Friday, December 7, Dave and I went to the gastroenterologist's office and I swallowed the camera-in-a-capsule. It seemed considerably smaller than the two I swallowed in 2004. I asked how I'd know if it had passed through. The MA said most people see it when it passes. Hmmmmm. Lucky them! 

I wore the transmitter and belt all day and showed up back at the office at closing time. It seemed to have worked well all day, the little blue light on the device hanging from my shoulder blinked twice each second, signifying that it was indeed photographing my inner gut. I felt much like I do on other days when the diarrhea is frequent. I watched for it to pass, hoping I'd have the assurance it made it all the way through. I drank a lot of water and worried, of course. I didn't see it, but unless it floats, it would be easy to miss. The MA told me to report any obstruction symptoms.

endoscopy capsules stuck
in somebody else's gut

So, when the crampy twinges and nausea were a little more noticable on Friday, I called. Dr. Cutler ordered an X-ray. The technician said the report probably wouldn't get to Dr. Cutler until Tuesday. So I asked to see the image. There it was! As clearly identifiable as the pelvic bones that framed it. The copy they gave me on a disc didn't open with any program I have, so here's a picture of some other poor woman who has two capsules stuck inside her.

double-balloon endoscopy

"What is that metal thing in there?" asked the technician. I explained, then called and left another message for Dr. Cutler's MA, requesting a double-balloon endocscopy instead of surgery if possible to retreive it. As it was the end of the day, they'll get back to me next week.

It doesn't hurt much so far. But I don't want to wait until it's an emergency. 

Déjà vu?

Note to self: Only swallow edibles!

I hope your holidays are great so far.

Beth