Capsule vs traditional endoscopy questions.

November 18, 2004 12:05 PM

So this upper-GI endoscopy thing I keep hearing about. Uh, is there anyway you can request one of those new capsule endoscopies? Apparently the also don't knock you out. Personally I'd rather have to swallow a capsule then have them snaking a tube down my throat while I'm awake. Can I demand being knocked out? Am I the patient that doctor's roll their eyes at?

No apostrophe. Doctors. Dammit.

So yeah this is hitting one of those "phobias" that we all have. God is smiting me. Here's the conversation:

"So uh, they don't knock you out?"
"No."
"I see. This is stupid, how much does it hurt?"
"Well, many people have it done. You can still breath during it."

Well thank God, I won't suffocate. I want a capsule. My internet search results in it being FDA approved. How does one go about finding a doctor who does it? Can any doctor do it if I can find a place to order it? The doctors I'm dealing with are kind of, uh, "just do it, don't be a wuss."

posted by geoff. to health & fitness (16 comments total)

Oh and for you medical professionals out there, it's because I have had nausea... took Zantac... stopped the nausea but now I have a tightness in my larynx/just below larynx (for about 2 months, not getting worse or better). Goes away when I swallow and eat. Doesn't follow meal patterns. Doctor said "Well let's check it out, but you're young and if we see cancer there you'll be in medical journals but it can be scarring or something." Also I have some white phlegm that occasionally comes up. That's just background for a little FYI.
posted by geoff. at 12:14 PM on November 18, 2004

I would hazard a guess the capsules are very expensive. And are you sure it's larynx, not esophagus? If it's your larynx, that goes to your lungs, not your stomach. You can't swallow a capsule and look at your larynx.

Also, I think the capsules are for stomach and intestinal viewing.

Did you talk to your doctor about your concerns with the procedure? I believe they can put you in twilight, but I'm not exactly sure.
posted by gramcracker at 12:37 PM on November 18, 2004

I can only speak for myself but seriously, while the tube is not exactly fun, it's really no big deal. It doesn't hurt, but it does make you gag a bit. In my case the doctors and nurses were really helpful and comforting, and it was all over pretty quickly. They do help you through it.
posted by different at 12:38 PM on November 18, 2004

Following up different's point, I had the procedure recently and it's really not bad. I was put under "conscious sedation" (not sure if that's the correct medical term) so I was completely out of it and only have a vague memory of someone saying "swallow." Also, you'll have a lozenge that paralyzes part of your throat so you won't have to worry about gagging. No pain at all, and all I really remember besides the "swallow" was waking up and drinking cranberry juice.
posted by jed at 12:52 PM on November 18, 2004

My dad works in the Upper GI unit at U of M - you need to be awake during the testing because you need to swallow, answer questions, etc. You can get a capsule endoscopy for certain problems, normally lower problems...

If you get a really good technician, you should be fine - they work with children, so they have to be really understanding and patient. You can also request a valium to help you chill on your way in/sleeping the night before.
posted by blackkar at 1:03 PM on November 18, 2004

Also, general anesthesia is nothing to take lightly. However minimal, there is *always* a risk to being put under. Why expose yourself to that unnecessarily. I am not trying to be uncompassionate (I have a wicked gag reflex myself), I just don't like trying risking my safety unless it is unavoidable.
posted by cayla at 2:31 PM on November 18, 2004

If I may take a breather from rolling my eyes...

Unfortunately a capsule basically won't cut it. It's used primarily to visualize the distal duodenum and small bowel, and only because you can't get to it with a normal EGD or from the other end. The capsule essentially yields much less information because it's under the control of peristalsis alone, and can't be guided by a tech or doctor. So you end up catching only glimpses of things. It's useless in your case because the area of interest is actually the larynx/esophagus, where the capsule would be for only a second before making it's way to your stomach.

But there is an alternative perhaps, if you're really against the EGD. If your problem does reside in the larynx, around the vocal cords (for example you may have a polyp there), then it may be worthwhile to see an ENT who can do some basic indirect laryngoscopy (painless), or (the slightly less invasive but still obnoxious) transnasal flexible laryngoscopy. Of course, this won't tell us anything about what's going on in your esophagus.
posted by drpynchon at 3:07 PM on November 18, 2004

What brand/maker is this capsule? The one I'm familiar with is still under research and not approved for humans by the FDA (or any other govermental body).
posted by skallas at 3:56 PM on November 18, 2004

skallas,

I know Given Imaging Ltd. developed a capsule that was FDA approved in 2001.
posted by drpynchon at 4:45 PM on November 18, 2004

Exactly what Jed said. Conscious sedation/twilight is where you're sedated enough to not remember much, but still conscious enough to comply.

It's commonly used for wisdom teeth extraction, too.

No need to roll your eyes, doctor. It's a completely valid question and valid responses.
posted by gramcracker at 5:11 PM on November 18, 2004

drpynchon, thanks. Wow, that's a big pill. I cant imagine actually swallowing that.
posted by skallas at 6:17 PM on November 18, 2004

Hey gram,

I know it's a valid question, otherwise I wouldn't have bothered to respond. But when you've made it through the wards, stuck enough chest tubes in coding patients, and seen enough people go through procedures entirely more noxious than an endoscopy, you'll be rolling your eyes a bit too. Like it or not, your perspective will be a-changing over the next few years.
posted by drpynchon at 6:37 PM on November 18, 2004

If I may take a breather from rolling my eyes at drpynchon...

Ask for some valium. That really helped me when I had to undergo a rather unpleasant medical procedure.

Alternatively, (if insurance allows) find a doc or clinic who will give you some Versed. It's sedating enough that you will remember little if any of the procedure, but with fewer risks than general anesthesia.
posted by kamikazegopher at 7:16 PM on November 18, 2004

Wow, that's a big pill. I cant imagine actually swallowing that.

Obligatory Futurama quote: "Good news, then! It's a suppository."
posted by kindall at 9:43 PM on November 18, 2004

drpynchon, I left a hospital AMA earlier this year because of a doctor who rolled his eyes as I cried my way through questions and belittled and brushed off my fears and concerns about a procedure I needed (actually, a modified endoscopy). If you can't deal with patient fear without being condescending, arrogant and rude, please do everyone a favor and become a pathologist.

And most certainly spare us your attitude in AsMe.
posted by Dreama at 7:02 AM on November 19, 2004

The tricky thing about oculokinetic rotatory nystagmus is that it's not under conscious control.

To geoff.:

Conscious sedation makes everything OK. Between the benzodiazepine, which makes all anxiety fall apart and disables memory formation; and the fentanyl, which imbues you with a 'Drugstore Cowboy' sort of feeling of general well-being, the endoscopy is likely to be the most pleasant part of your day - and the least well remembered.

After hearing about your symptoms, it seems like you want your doc to get a good look at the whatever-it-is. So I submit that the hard part is going to be getting into the doctor's office and sitting down in the chair. Just remember that the drugs are going to be there for your comfort - and try not to worry! Upper endoscopy is generally a very well tolerated procedure.
posted by ikkyu2 at 9:27 AM on November 19, 2004