article about Pillcam ESO -- alternative to endoscopy
Camera capsule easy to swallow as diagnostic tool
By David Kohn
Tribune Newspapers: The Baltimore Sun
Published April 24, 2005
It sounds like something out of a James Bond movie: a pill-sized gadget equipped with two cameras, each of which takes seven photos a second and transmits them wirelessly to a nearby storage device.
But the only thing this gadget will spy on is your esophagus. Known as the Pillcam ESO, the high-tech capsule is gaining fans among patients and doctors as a comfortable, convenient alternative to endoscopy.
"It's ridiculously easy to use," said Dr. Blair Lewis, a gastroenterologist at Mt. Sinai Medical Center in Manhattan.
Lewis began using the device four months ago to diagnose a range of esophageal disorders, including gastroesophageal reflux disease, esophagitis and esophageal cancer.
Before that, Lewis used an endoscope, essentially a long tube with a camera mounted on one end. Endoscopy is much more involved and invasive than the Pillcam. Patients have to be sedated, which means they miss a day of work, even though the procedure itself takes only a half-hour or so.
Like a vitamin
With the Pillcam ESO, patients simply swallow the device, which is the size of a large vitamin tablet. It works its way down the esophagus, usually reaching the stomach in less than 10 minutes.
During that time, it shoots a few thousand photos, which are transmitted to a device where software turns the images into a kind of movie reel of the patient's esophagus, allowing the doctor to review the results immediately.
The procedure is painless; the patient feels nothing. Within a day or two, the Pillcam leaves the body in a bowel movement. The tablets, which cost $450 apiece, are not reused.
"That's the most common question we get," said Yoram Ashery, vice president for business development at Givens Imaging, the Israeli biotech company that makes the Pillcam. "You definitely get a new one."
Since the Food and Drug Administration approved Pillcam ESO in November, the device has been adopted by a small but growing number of gastroenterologists across the country.
"It's much easier on the patient," said University of Maryland Medical Center gastroenterologist Eric Goldberg, one of the first doctors in the area to use the device.
A good alternative
Les Hydovitz agrees. Although he suffers from acid reflux disease, he had always refused an esophageal endoscopy.
"I'm scared to death to have one," said Hydovitz, who owns a towing company in Reisterstown, Md. "I can't deal with someone putting something down my throat."
When Goldberg wanted to check Hydovitz for an esophageal inflammation, he suggested the Pillcam. Hydovitz agreed, and recently at Goldberg's office, he swallowed one. "It was neat, actually," he said. "It definitely beat the other way."
Within minutes, Goldberg was looking at the photos, and he found that Hydovitz didn't have any esophagus problems.
The procedure costs about $1,000. An upper endoscopy, by contrast, costs about $1,600, not including time lost from work. Because most insurance companies do not cover Pillcam ESO, patients may have to pay for it themselves. Givens Imaging is trying to persuade Medicare to begin paying for the procedure. Once Medicare covers it, most other insurance companies will likely follow suit.
This device actually is the second in the Pillcam series. The first, Pillcam SB, has been used since 2001 to detect ailments of the small intestine, such as Crohn's disease, intestinal cancer and gastrointestinal bleeding. ("SB" stands for small bowel, another name for the small intestine.)
2 pictures a second
Pillcam SB shoots two pictures a second; during the six to eight hours it takes to make its way through the small intestine, it snaps thousands of photos, which are transmitted to a recorder worn by the patient. More than 170,000 patients around the world have undergone the procedure, which is covered by most insurance companies.
Givens Imaging is working on capsules designed to record images in the colon and the stomach, requiring modifications for each organ. For example, because the stomach has a larger diameter than the esophagus or the small intestine, the camera must be adapted.
Pillcam does have some disadvantages. Unlike an endoscope, it cannot be outfitted to take tissue samples, an important consideration if the patient may have cancer. "If I have a patient who needs a biopsy, I'll do an endoscopy," Goldberg said.
There also is a chance that the Pillcam can get stuck making its way through the gastrointestinal tract.
Goldberg said this happens in one of every 200 patients. When it does, doctors must extract it with an endoscope equipped with a small basket or net. If it lodges in a particularly difficult spot, the doctor may have to perform surgery to remove it.
Hydovitz, for one, was willing to take that risk. "It's not tiny," he said of the Pillcam. "But they gave me a glass of water, and it went right down."
Copyright © 2005, Chicago Tribune
This is a great tool to get more people to have endoscopys, however, if the camera sees something, you will still need to have an normal endoscopy to have a biopsy taken...this will mean double the expense. It's just like the virtual colonoscopy...it's easy, but, if a polyp is detected you will need the normal colonoscopy to get at the polyp.
May be a good screening tool where biopsies are not expected or as a followup to non complicated cases. The thing that bothers me...."There also is a chance that the Pillcam can get stuck making its way through the gastrointestinal tract. Goldberg said this happens in one of every 200 patients. When it does, doctors must extract it with an endoscope equipped with a small basket or net. If it lodges in a particularly difficult spot, the doctor may have to perform surgery to remove it."
I'm an optimist. I figure they can sort out the getting stuck problem. I would think also that if its like most other electronic gadgets, the price ought to get real cheap in a few years. Maybe down to a few hundred dollars. In fact, as they make more of them, they should get cheaper. It seems entirely possible that people going in for a consult about gerd might well get the pill cam on the spot.