Small bowel capsule endoscopy

Proper bowel preparation is essential to ensure the highest possible quality of the video capsule endoscopy. If food residue, cloudy fluid, or mucus remains in the intestines, image quality may be compromised, and the doctor may miss small but clinically significant changes.

Therefore, a special diet must be followed before the examination, and an intestinal preparation solution must be taken in stages—similar to the preparation for a colonoscopy. European guidelines for small bowel capsule endoscopy often recommend a polyethylene glycol (PEG) solution, as it can improve bowel visibility during the examination.

2–3 days before the examination

A few days before the examination, it is advisable to choose a diet that is easier to digest and avoid foods that may remain in the intestines longer or impair visibility.

It is recommended to avoid:

• seeds, nuts, grains;
• whole-grain bread and rye bread;
• berries with seeds;
• tomatoes, cucumbers with skin;
• cabbage, legumes;
• mushrooms;
• foods very high in fiber.

You may choose easily digestible foods: white bread, rice, pasta, peeled potatoes, eggs, lean meat, fish, broth, plain yogurt, unless your doctor has advised otherwise.

If you are taking iron supplements, activated charcoal, or other medications that may discolor the intestinal contents or interfere with image evaluation, inform your doctor in advance. The doctor will tell you if and when these medications should be temporarily discontinued.

The Day Before the Examination

On the day before the examination, your diet should be very light. Generally, you may still eat light meals during the first half of the day, but later you should switch to clear liquids.

Permitted clear liquids:

• water;
• light tea without milk;
• clear broth;
• clear apple juice;
• still or lightly carbonated water;
• clear electrolyte drinks without red or purple coloring.

Not recommended:

• milk and milk-based beverages;
• coffee with milk;
• smoothies;
• thick juices;
• alcohol;
• red, purple, or very dark beverages.

Bowel preparation solution in a split regimen

The exact name and amount of the preparation are determined by the doctor or clinic. The most commonly used bowel preparation solution is taken in a split-dose regimen—one part the evening before the exam and the other part on the morning of the exam.

The evening before the exam:

Drink the first portion of the bowel preparation solution according to the clinic’s instructions. It is recommended to drink the solution slowly, in small sips. Clear liquids should also be consumed at the same time, if indicated in the preparation’s instructions.

On the morning of the exam:

Drink the second portion of the preparation solution. It is very important to finish the solution within the time specified by the clinic, usually several hours before swallowing the capsule, so that the intestines are clean and the amount of fluid does not interfere with the quality of the exam.

If you experience nausea, bloating, or discomfort while drinking the solution, you may pause for a short time and resume drinking more slowly. If symptoms are severe or you are unable to finish the solution, contact the clinic.

On the day of the examination

You must arrive for the examination on an empty stomach. Generally, you should not eat or drink before swallowing the capsule, unless your doctor has given you different instructions. For small bowel capsule endoscopy, fasting for approximately 10–12 hours is usually recommended, but the specific schedule may vary depending on the clinic’s protocol.

It is recommended to wear comfortable, loose-fitting clothing to the examination, as a recording device will be attached to your body or around your waist. This device captures the images transmitted by the capsule, so it must not be removed, wetted, or disconnected during the examination.

The capsule is swallowed with a small amount of water. After swallowing, the capsule begins to move through the digestive tract and capture images.

What can you do after swallowing the capsule?

After swallowing the capsule, you should generally not eat for the first few hours. Clear liquids are usually allowed after about 2 hours, and a light meal after about 4 hours, unless your doctor or clinic has instructed otherwise. This regimen is also described in ASGE materials on capsule endoscopy.

On the day of the examination, you should avoid:

• intense physical activity;
• running;
• jumping;
• sudden bending;
• showers, baths, saunas, or swimming pools until the recording device has been removed;
• magnetic resonance imaging (MRI) until it is certain that the capsule has been passed.

Generally, the patient can walk, stay at home, or engage in gentle daily activities.

When is the capsule expelled?

The capsule is expelled naturally through bowel movements. Usually, the patient does not feel it. The capsule is not reusable, and there is no need to return it to the clinic unless the clinic has given specific instructions.

If you experience severe abdominal pain, vomiting, significant abdominal bloating, fever, or an absence of bowel movements or gas after the examination, contact your doctor immediately.

Is video capsule endoscopy safe?

Video capsule endoscopy is a safe and painless method; however, like any examination, it has certain limitations. The most significant risk is capsule retention in the intestines, which is more likely in patients with intestinal strictures, a history of surgery, Crohn’s disease, or suspected intestinal obstruction. Therefore, before the examination, the doctor will assess whether the method is suitable for the specific patient. Capsule retention is a known but rare complication.

Before the examination, be sure to inform your doctor if you have:

• a history of intestinal obstruction;
• known or suspected intestinal stricture;
• Crohn’s disease;
• a history of intestinal surgery;
• swallowing difficulties;
• a pacemaker or other implanted electronic device;
• pregnancy;
• diabetes;
• kidney, heart, or severe systemic disease;
• medications taken regularly, especially insulin, diabetes medications, blood thinners, or iron supplements.

Video capsule endoscopy is a diagnostic method—it allows for the examination of the intestinal mucosa, but it does not allow for the collection of biopsies or the performance of therapeutic procedures. If significant changes are found during the examination, the doctor may order additional tests or treatment.

Proper preparation is one of the most important factors for a high-quality examination. The cleaner the intestines are, the greater the chance of obtaining clear, informative images and an accurate medical diagnosis.

2–3 days before the exam: Avoid seeds, nuts, whole grain products, berries with seeds, and foods that are very high in fiber.

The day before the exam: eat a light meal, then switch to clear liquids. Do not consume milk, smoothies, thick juices, alcohol, or red/purple-colored beverages.

B Bowel preparation:B Take the bowel preparation solution prescribed by your doctor in two doses—one portion the evening before the exam and the other portion on the morning of the exam.

B On the day of the exam:B Arrive on an empty stomach, wearing comfortable clothing. After swallowing the capsule, do not remove the recording device and avoid strenuous physical activity.

After the examination: the capsule is excreted naturally. If you experience severe abdominal pain, vomiting, fever, or lack of bowel movements/gas, contact your doctor immediately.