When the White Queen assured Alice in Wonderland that she was able to believe “as many as six impossible things before breakfast,” the idea of swallowing a tiny camera first thing in the morning was probably not on her list.

But thanks to a new procedure called video capsule endoscopy, some patients with gastroenterological symptoms are doing just that. The camera, enclosed in a pill about the size of a large vitamin supplement, is swallowed early in the morning on an empty stomach; the patient drinks water two hours later and eats a light lunch two hours after that to encourage the gastric and intestinal contractions that move the video capsule along. During its eight-hour passage through the digestive tract, the camera transmits images of the small intestine to a monitoring device around the patient’s waist. The resulting pictures, downloaded into a computer, allow the clinician to see parts of the small intestine that are not visible through a regular endoscope.

According to Deborah D. Proctor, M.D., associate professor of medicine (digestive diseases), who has been using the technique since it was introduced at Yale last spring, it is helpful in diagnosing hidden gastrointestinal bleeding where upper endoscopy and colonoscopy are inconclusive. It is also useful in obtaining information about management of chronic problems such as Crohn’s disease, which depends on the degree to which the disease is located in the small intestine. “Upper endoscopy shows only about a foot of small intestine,” Proctor noted. “The enteroscope shows only about another 6 to 8 feet—a total of about one-third to one-half of the small intestine. With the camera we can see the entire small intestine in about 85 percent of patients who undergo the procedure.”

Scanning technology—using a camera at the end of a scope to transmit data, as is done with an endoscope—has been around for about 15 years, while fiber optic technology has been around for about 30 years. What is new here is the camera-inside-the-pill—a technique that originated in Israel four years ago and is currently in use at Yale and 250 other facilities around the country.

“The procedure is totally noninvasive; no radiation is involved, there is no discomfort and no need for sedation,” she said. “Once the camera and belt are in place, patients can go about their normal day.”

The only contraindication is for those patients whose GI tracts might be obstructed, preventing the capsule from moving through. For all others the capsule moves painlessly through the GI tract and is excreted.

“This is so safe that we’ve started using it with children—as long as they weigh over about 50 pounds,” Proctor said. “Being able, for instance, to see active bleeding and know exactly where it is coming from has great potential to improve GI disease diagnosis and management.”