The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on wireless capsule endoscopy for investigation of the small bowel.
Obscure gastrointestinal bleeding is defined as bleeding of unknown origin that persists or recurs after a negative initial endoscopy (colonoscopy and/or upper gastrointestinal endoscopy). Diagnosis may be difficult because bleeding can often be slow and/or intermittent. Patients may experience prolonged blood loss, leading to iron deficiency (anaemia) and a feeling of tiredness.
Small intestinal bleeding can result from a number of conditions, including vascular lesions (angiodysplasia), small bowel tumours, coeliac disease and Crohn’s disease (which may be suspected because of other symptoms).
The patient swallows a small capsule, usually after an overnight fast. This capsule consists of a camera, a light source and a wireless circuit for the acquisition and transmission of signals. As the capsule moves through the gastrointestinal tract, images are transmitted to a data recorder, worn on a belt outside the body. These data are transferred to a computer for interpretation. The capsule is then passed in the patient’s stool and not used again.
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.