Our guts can give us problems.
But for much of modern medicine, the gut — technically the small intestine or small bowel — have been hard for doctors to reach and treat.
The organ lies between the stomach and the colon and its 22-plus feet are all folded up inside.
In recent years, less invasive techniques have emerged, making it easier for doctors to diagnose problems, in particular unexplained bleeding in the digestive tract. Doctors at Mount Sinai Medical Center and Baptist Hospital are among those who are using procedures like capsules with microscopic cameras and balloon-equipped scopes that can travel inside the guts.
Dr. Jamie Barkin, chief of gastroenterology at Mount Sinai Medical Center, said previously doctors could only see the small intestine on X-ray. Or they could reach the very top of the tract through the stomach, with an upper endoscopy, or reach the very bottom with a colonoscopy. That limited their ability to see the whole organ and details in the lining. An X-ray could miss a small ulcer, small growth or some inflammation, Barkin said.
Within the last 10 years, a group of doctors in Israel invented a vitamin-sized pill that contains a microscopic camera. The pill, which travels through the digestive system, takes 50,000 pictures along the way and sends them electronically to an external device.
“This opened up the black box,” said Barkin, who was part of the international group working on the new procedure.
“It brought physicians into understanding a whole new organ and its diseases … We’ve figured out a whole new set of diseases, a whole new set of treatments and we’ve explained symptoms.”
His patient, Carmelo Sanchez, 59, took the pill recently. Barkin is searching for what is causing his chronic anemia, which requires regular iron infusions. “The only way to be thorough is to do it with the camera,” Sanchez said. “We wanted to get to the bottom of it.”
So in August, Sanchez went to the hospital, got outfitted with the external receiving device (“like a purse you wear over your shoulder” as he described) and swallowed the pill. He left, went to work and at the end of the day returned the device — now full of thousands of pictures — to the hospital. The capsule later passed through his digestive system.
With the photos, Barkin was able to rule out any lacerations or other problems in Sanchez’s small bowel. “It’s very relieving to know,” Sanchez said.
Barkin said the camera-equipped capsules are recommended for patients, depending on their symptoms. “If you have symptoms of small-bowel disease — abdominal pain, diarrhea, change in bowel habits — I’d suggest we start with an X-ray to make sure there’s not a blockage,” he said.
“If your only symptom is bleeding and there is no other discomfort or change and the GI doctor has looked at the colon and stomach and hasn’t seen the source of the bleeding, then he’d give you a capsule.’’
Barkin said capsules have benefited people with unexplained GI bleeding.
They are generally not recommended if there is a known obstruction in the tract.
Another less-invasive option is a balloon-assisted enteroscopy.
In the procedure, a slim tube-like camera is threaded through a sleeve, said Dr. Javier Parra, a gastroenterologist at Galloway Endoscopy Center, a joint venture with Baptist Health South Florida.
“This sleeve has a balloon. The balloon is inflated and pulled back, creating an accordion effect, or pleating. The balloon thereafter is deflated and the whole process repeated as we gain ground into the small bowel,” he wrote in an email. “As the balloon is inflated, it catches the bowel from inside. Imagine going through a tunnel and trying to make it shorter by grabbing the inside walls and pulling them toward the entrance.”
The balloon-assisted enteroscopy is another way to open up the black box of the small intestine. It first evolved in Japan and new balloon techniques were further developed in the United States.
Parra called it an “important tool in the arsenal of the gastroenterologist.” He explained it can help control bleeding for patients in whom other technologies cannot reach. Parra can also use it to mark areas for surgery, thus avoiding risks and cutting down surgery time. Sometimes it can eliminate the need for surgery altogether by removing precancerous lesions.
Most of Parra’s patients suffer from undiagnosed sources of bleeding and have been transfused with 10-20 units of blood. With the balloon-assisted therapy, he can look for the site of the bleeding inside the tract, cauterize it and lower the risk of more bleeding.
While the camera-equipped capsules travel the entire intestine, the balloon-assisted enteroscopy can examine 60-70 percent of the bowel at one given time, Parra said. Sometimes they can travel the whole distance, but that’s not common. Parra said most problems are found in the first two-thirds of the organ.
“It is more invasive than capsules, but that gives it the ability to treat issues, mark them for surgery and deal with the problem in a more definite manner. However, in some cases, capsule and device-assisted enteroscopy, could be considered complementary,” Parra said.