Minimally invasive techniques can be used to diagnose most gastrointestinal conditions, such as ulcerative colitis or diverticular disease. Gastroenterologist Professor Owen Epstein specialises in minimally invasive procedures and here he explains the different tools used to make a diagnosis, how they work and what the future holds for technologies in gastroenterology.
What techniques do you use and how do they work?
The following techniques are used to diagnose gastrointestinal conditions:
Capsule endoscopy (PillCam)
Capsule endoscopy is a new device in gastroenterology. The capsule is swallowed with water, propelled by the natural movement of the digestive tract and wirelessly transmits a video of the inner lining of the bowel from mouth to rectum. Because the majority of patients undergoing upper and lower fibre-optic endoscopy do not have serious damage to the lining, the less invasive capsule endoscopy can scout out the landscape and only if necessary, calls on traditional fibre-optic endoscopy to biopsy or remove a significant polyp. The capsule has good accuracy and asks the question "who needs an endoscopy?".
Virtual CT colonoscopy
Virtual colonoscopy uses CT scanning to provide images of the large intestine. A small flexible rubber tube is passed through the anus into the rectum and the large intestine is inflated with carbon dioxide. Prior to the procedure, patients drink a contrast agent allowing a computer program to "subtract" any residual bowel debris and excellent images of the gas-distended bowel are obtained. The procedure has the same accuracy as fibre-optic colonoscopy for polyps and diverticulosis but is unable to accurately diagnose colitis (inflammation) or bleeding blood vessels (angiodysplasia).
Echogastrography
This is an ultrasound test. The patient drinks a cup of tomato soup and the radiologist can then observe stomach contractions as they occur in real time. The test is used to assess the pumping mechanism of the stomach. It is very useful when investigating patients with indigestion (nausea and/or upper abdominal discomfort), in who there is no evidence of damage to the lining on fibre-optic or capsule endoscopy of the stomach.
How readily available are these diagnostic techniques?
Most hospitals can offer virtual colonoscopy but fewer have expertise in whole bowel capsule endoscopy and echogastrography.
What advancements could be made in minimally-invasive technologies for gastroenterology?
In the next decade, capsules will be developed that use light-physics or sonar to provide "biopsy" information. There is also an early prototype capsule that can be delivered without the need to clear the bowel with laxatives.
What does the future look like for minimally-invasive gastroenterology?
Miniaturisation and chip technology will continue to advance the evolution of gastrointestinal diagnostic devices, providing patients with much less invasive options that can be safely and painlessly delivered in primary care or even in the home.
Do not hesitate to book an appointment with a specialist about your options in diagnosing a gastrointestinal problem.
Professor Owen Epstein is a renowned and pioneering professor of gastroenterology, based at the Royal Free Hospital in Hampstead, London. He has a special interest in the innovation of healthcare and the technologies used to ease the patient journey. These include whole bowel wireless capsule (pill) endoscopy and hydrogen or 13C breath testing variously for lactose intolerance, small intestinal bacterial overgrowth, Helicobacter pylori, stomach pump function and colon cancer scree...
Professor Owen Epstein is a renowned and pioneering professor of gastroenterology, based at the Royal Free Hospital in Hampstead, London. He has a special interest in the innovation of healthcare and the technologies used to ease the patient journey. These include whole bowel wireless capsule (pill) endoscopy and hydrogen or 13C breath testing variously for lactose intolerance, small intestinal bacterial overgrowth, Helicobacter pylori, stomach pump function and colon cancer screening using minimally invasive colon capsule endoscopy. He also has considerable experience in the physiological assessment of the vagus nerve and stress and, in particular, its relationship to abnormal gut feelings. Professor Epstein has had a hugely successful career and is regarded as one of the leaders in minimally-invasive techniques and a gentler patient journey.
Professor Epstein is widely published with more than 100 reviewed publications to his name. He is the senior author of the best-selling textbook Clinical Examination and the originator of the 'The Map of Medicine', which is a key online resource used by healthcare professionals. He founded the Royal Free Screen Based Simulation Centre, where medical and surgical gastroenterologists use virtual reality to acquire mastery of endoscopy and laparoscopic surgery prior to engaging in live procedures. More recently, Professor Epstein has introduced new and minimally-invasive assessment tools and founded a new 'Institute for Minimally Invasive Gastroenterology (IMIGe)' at the Royal Free. He is director of the IMIGe Academy for Capsule Endoscopy which teaches aspiring capsule practitioners. Professor Epstein is award-winning and, over the years, has received research grants amounting to more than £1 million. He has contributed hugely to new medical technologies that change the patient's journey, and continues to do so.
Professor Epstein works out of the Royal Free PPU where he currently runs one of the UK’s leading PP colon capsule units. Professor Epstein is currently the lead clinician on the advisory panel of the new NHS England Colon capsule endoscopy colon cancer screening pilot (50000 patients)
He has also developed the capsule endoscopy curriculum(small and large intestine) for teaching novice NHS England gastroenterologists how to read and report capsule endoscopy. He has mentored over 400 UK gastroenterologist as well as aspiring capsule readers in Europe, Hong Kong, West Africa and the Amercias.s.Professor Epstein is a regular invited speaker to major international conferences on capsule endoscopy.
Over the past few years, Professor Epstein and his team have developed a unique investigation unit to monitor vagus nerve function in patients with IBS, functional dyspepsia and other "functional disorders". This is based on a wearable device that continuously measures heart rate variability over 3 days to establish whether or not the there is a "software" disorder underlying unexplained or gastroenterology drug unresponsive disorders. He has considerable experience of offering non invasive vagus nerve stimulation to appropriate patients with abnormal vagus nerve function (using gammaCore).
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