A PillCam Got Stuck In This Man's Gut for 8 Weeks
Technology's relentless pace sometimes trips up too.
Given the choice between taking several feet of camera cable up the rectum or swallowing a pill-sized camera, I’m thinking just about everyone takes the small camera pill, right? So when the FDA announced that it approved the “PillCam” for use earlier this week, it seemed like good news: people who couldn’t have a regular colonoscopy would instead swallow a PillCam, which, even at $500, costs only a fraction of the $4,000 procedure. I didn’t even consider that pills aren’t supposed to pass through the human body whole, and that a PillCam could get stuck midway through its incredible journey—until Scott Willis emailed us to tell me about the time he had a PillCam lodged in his gut for eight weeks.
While the PillCam was just approved for colon inspection in 2001, the FDA approved a similar device, another PillCam made by the same company, Given Imaging, for looking at the small intestine.
In 2004, Scott was having abdominal spasms, but a traditional colonoscopy and two different small bowel x-ray series were coming up empty. The remaining option was exploratory abdominal surgery. A decade earlier, Scott had been diagnosed with Crohn’s disease. He had to have “small bowel resection” surgery, which resulted in the removal of 4 inches of large intestine and 8-10 inches of small intestine.
“Not a pleasant experience,” he told me.
So when Scott’s doctor at Indiana University Medical Center told him about the PillCam, even when he explained that there was possibility of a “full intestinal blockage” which would require immediate surgery, he saw the appeal. It had been used on other patients, it was FDA-approved, and it was just like taking a pill, right?
Okay, it’s a pill that’s made with Israeli missile defense technology, carrying a tiny camera, its own batteries, transmitting equipment, and tiny LED lights. Scott told me that when the nurse he worked with at IU Med found out he was an electrical engineer, she gave him a PillCam that wouldn’t activate to take home and disassemble, which he did with glee. “Yeah, I’m a geek,” he added.
After adhering to the standard clear liquid diet for 24 hours, a “cleansing prep” the night before, and multiple enemas to prep his GI tract for the big shoot, the nurse activated his PillCam by touching it to the receiver belt, and Scott swallowed the now-blinking pill. Once it was down the hatch, Scott put on the receiver belt and went to the Circle Center Mall and then to a car show. For eight hours, the PillCam worked its way down his esophagus, through his stomach and into his small intestine—all the while transmitting seven images per second to the receiver belt.
Overall, not a bad way to spend an afternoon, although the receiver belt and its attached batteries made Scott a little worried he’d be “mistaken for a suicide bomber.”
I always seem to do things the hard way.
The PillCam should have passed through his empty system in 16-36 hours. As Scott described it, “they gave me a plastic hat type of device to eliminate in, so I would be sure the PillCam had passed,” but after a couple of days, no PillCam passed.
He called his GI doctor who ordered an x-ray. Sure enough, the PillCam was still midway through the small bowel. When the doctor from IU Med returned from Christmas vacation, he reviewed the footage and found that it had become lodged between the two Crohn’s inflamed spots in Scott’s small intestine, having gotten past the first but stuck to the second. It wasn’t the complete blockage that his doctor warned him about, which would’ve hurt like a kidney stone and needed emergency surgery. It was instead “just” a partial block.
Thus began the attempt to get it out. “We tried several things, mineral oil, sleeping with my body inclined (head down), I hung a bar from the floor joists in the basement to hang upside down. All trying to get that infernal PillCam to dislodge and pass,” Scott said.
All to no avail, alas. “So it was surgery again for another small bowel resection/camera removal,” he said. “I always seem to do things the hard way.”
Hard, and perhaps even record-breaking. “The surgeon contacted FDA and Given Imaging and neither had had a report of anyone going eight weeks with the PillCam stuck,” Scott said, with what might even have been a trace of pride.
In spite of this, Scott still seems to like the PillCam; he just contacted us because “the more the more folks know about the procedure the better.” He said he’d do the PillCam again if he needed to. The FDA approved the colonoscopy PillCam only in cases where the standard procedure can’t be done. And because the PillCam’s pictures weren’t as clear as the in-office procedure, but for the small intestine, it can be the best option, giving better visual insight than a CT endoscopy.
“I think the PillCam procedure is a good diagnostic tool, just my situation was on the extreme end of things and something the medical community had not experienced before,” he said. If his Crohn’s disease flare up again he wouldn’t be adverse to another camera pill, although if the flare up were bad enough, it’d mean surgery much sooner than eight-weeks. Maybe it's a good parable for how technological advances often work in the real world then; an important step forward, perhaps, but also imperfect, clumsy, and stuck in your gut for two months.