Cameras in a pill? Gulp.

Swallow and smile: Your esophagus is getting the latest high-tech checkup

Medicine

April 15, 2005|By David Kohn | David Kohn,SUN STAFF

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," says Dr. Blair Lewis, a gastroenterologist at Mount 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.

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," says Yoram Ashery, vice president for business development at Givens Imaging, the Israeli biotech company that makes the Pillcam. "You definitely get a new one."

'Easier on the patient'

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," says University of Maryland Medical Center gastroenterologist Eric Goldberg, one of the first doctors in the area to use the device.

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," says Hydovitz, who owns a towing company in Reisterstown. "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 last month at Goldberg's office, he swallowed one.

"It was neat, actually," he says. "It definitely beat the other way."

Within minutes, Goldberg was looking at the photos, and he found that Hydovitz didn't have any problems with his esophagus.

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 is actually 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).

Pillcam SB shoots two pictures a second; over 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, which requires 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's risks

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," says Goldberg.

There is also a chance that the Pillcam can get stuck making its way through the gastrointestinal tract.

Goldberg says 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 says of the Pillcam. "But they gave me a glass of water, and it went right down."

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