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    Intestinal 'Inner Space' - Coming to a Doctor's Office Near You

    Imagine swallowing a capsule with a tiny camera that travels through the small bowel, taking pictures of the intestinal wall as it works its way through your digestive system. Such a story sounds like a cross between a science fiction plot, a James Bond or Mission Impossible gadget and "Inner Space," the comedy film in which Dennis Quaid travels through Martin Short's bloodstream in a tiny spaceship-like vehicle.

    Believe it or not, such a device exists and has been tested on humans - 11 of them - including one of its inventors, Dr. David Swain, a gastroenterologist at the Royal London Hospital in England. He debuted this tiny traveling camera during a presentation at the Digestive Disease Week conference in San Diego. The gathering attracted gastrointestinal experts from around the world.

    "We will initially use the device for patients with (suspected) bleeding in the small bowel," Swain said. "Currently, we're limited in visualizing the small bowel because of problems of discomfort and failure to advance far into the small bowel (using conventional swallowed flexible instruments)."

    In other words, the small intestine - the stretch of bowel between the stomach and the large intestine - is difficult for doctors to see. It is almost always impossible to insert an endoscope into it from the rectum, and the small bowel doesn't always visualize well on a barium x-ray. Instruments passed very far into the small bowel from above may be technically difficult and/or quite uncomfortable. So the challenge was to develop a "wireless endoscopy."

    What Swain and some Israeli scientists produced is a shiny white capsule about 1 inch long and 1/3 inch wide that has a clear dome on one end. The capsule resembles "Star Wars" robot R2D2 without limbs. When the capsule is removed from its small plastic case, a tiny beacon, which acts as the camera's flash attachment, begins flashing. The miniature transmitter and antenna are powered by silver oxide batteries.

    "Even though it looks large, it's really quite easy to swallow," Swain told a somewhat skeptical audience.

    The capsule reaches the small intestine about an hour after swallowing it with water, then takes about two hours to travel through. The lens, which is actually cleaned as it moves through the bowel, takes two pictures a second. These images are transmitted via a radio signal and then stored on a portable recorder that is carried on a belt worn by the patient. The images are later downloaded on a computer for analysis.

    "These are images we've never seen before," Swain explained. "We began working on this about five years ago, but there's been a huge jump in technology this past year that has made it (the current version of the capsule) possible."

    Using the device requires no preparation except fasting for a few hours before the test, and "a doctor doesn't even have to be with the patient because the device will make readouts."

    The capsule is eliminated in the stool and is disposable, although Swain retrieved the one he swallowed via "an ingenious little net devised by my co-workers" to see if the capsule sustained the journey through the small bowel intact without damage. It did.

    Researchers are planning on testing the device in the US later this year.

    In the future, Swain hopes the device can be used to visualize the large bowel, but that will require more light and faster motility. Currently, it takes six to seven hours for the capsule to travel through the large intestine.

    What the capsule doesn't do is perform biopsies or remove or treat polyps, often a precursor of cancer, "but it may eliminate unnecessary surgeries," Swain said.

    Asked about the cost, the gastroenterologist inventor said that if capsules can be manufactured in mass quantities, they would be relatively inexpensive.



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