Imagine a vitamin-sized capsule filled with a tiny video camera, a lens, four LED lights, two batteries, and a transmitter, travelling through your digestive system as it transmits over 50,000 images to a recording device around your waist. Does this sound like science fiction? It’s the M2A wireless endoscopy capsule, an incredible new diagnostic technique that is revolutionizing investigation of the gastrointestinal (GI) tract.
Hamilton Health Sciences’ gastroenterologists are conducting a pilot project to determine the extent to which capsule endoscopy will replace intestinal angiography. This is the first study to evaluate the economics of providing M2A in relation to the realities of Canadian clinical practice.
“In order to achieve appropriate and timely widespread adoption of a costly technique, it is important to document the precise indications for using this technique,” said Dr. David Armstrong, Medical Director, Digestive Disease and Surgery Program, Hamilton Health Sciences.
Dr. Armstrong is the principal investigator on the one-year pilot study being done in collaboration with McMaster University’s Division of Gastroenterology. He has teamed up with colleagues Dr. John Marshall who has extensive experience in economic analysis of the costs of managing gastrointestinal bleeding, and Dr. David Morgan who has studied GI bleeding from vascular lesions in the small intestine. Together they will evaluate and make recommendations on the feasibility of covering or reimbursing patients for the $900 cost of the M2A capsule.
Capsule endoscopy is expanding the scope of GI investigation in many ways. M2A produces excellent, high-quality images of vascular lesions in the small intestine, the 21-foot section between the stomach and colon. The painless procedure is as easy as swallowing a pill and does not require sedation. In fact, the patient can leave the clinical environment for several hours while the M2A capsule is in transit through the GI tract.
The M2A acronym stands for “mouth to anus” which succinctly describes the journey the capsule takes through the digestive system. The disposable capsule is swallowed painlessly then excreted naturally after its journey is complete.
Using traditional GI investigation methods, it is difficult for physicians to obtain a clear view of the small intestine. Consequently, many patients with bleeding in that area have to endure several traditional endoscopies before physicians can identify lesions responsible for blood loss.
To be eligible for this study, patients with obscure GI bleeding will receive complete standard investigations. If the physician decides that an angiogram is necessary, the patient will also receive the M2A capsule. The study will then compare angiography and the M2A capsule with respect to their accuracy in determining the cause of GI blood loss. “We’ve had great success recruiting patients for this study. All of the patients have had endoscopies before, and are thrilled to have the opportunity to simply swallow a capsule and go about their business for the day,” said Dr. Armstrong.
In addition to locating obscure bleeding, M2A may also be useful to diagnose many other diseases of the small intestine including Crohn’s disease, celiac disease, unexplained abdominal pain with diarrhea, and iron deficiency anemia. The use of M2A in the pediatric population is still under evaluation in clinical trials.