The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Assessing motility of the gastrointestinal tract using a wireless capsule, in September 2014.
The procedure is used to investigate gastrointestinal (GI) motility-related symptoms. Motility disorders can sometimes be difficult to diagnose: they include conditions such as gastroparesis and slow transit constipation. Gastroparesis is a chronic disorder of the stomach characterised by delayed gastric emptying in the absence of mechanical obstruction. Treatment includes: medical therapies (such as erythromycin and metoclopramide), botulinum toxin, gastric electrical stimulation, jejunostomy, and parenteral nutrition.
Slow transit constipation comprises a number of symptoms including straining, hard stools, sensation of incomplete evacuation and infrequent bowel movements. Management includes medical therapies such as laxatives and lifestyle advice (for example increasing exercise, and intake of water and fibre).
The standard procedure used to assess upper GI motility is gastric emptying scintigraphy. It involves ingestion of a standardised radiolabelled meal. An X‑ray is taken after 4 hours to determine the extent of gastric emptying.
Slow transit constipation is assessed using a radiopaque marker examination. The patient ingests a number of radiopaque markers and has one or more X‑rays after a predefined time (usually 4 or 5 days) to determine whether markers have been evacuated.
G80.2 Wireless capsule endoscopy
Includes: Capsule endoscopy NEC
The Clinical Classifications Service has advised NICE that currently these are the most suitable OPCS-4 codes to describe this procedure. The OPCS-4 classification is designed to categorise procedures for analysis and it is not always possible to identify a procedure uniquely.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.