8819 W. Victoria Ave.   Kennewick, WA  99336    509-460-5500 

PREPARATION AND INSTRUCTION FOR CAPSULE ENDOSCOPY Your physician has determined that you should undergo an examination called a "capsule endoscopy" as part of your medical evaluation.  Capsule endoscopy is indicated for visualization of the small intestine mucosa as an adjunctive tool in the detection of abnormalities of the small intestine. The capsule endoscope has only been studied in patients with obscure gastrointestinal bleeding.  Obscure gastrointestinal bleeding is bleeding of an unknown origin or source that persist or recurs in the small intestine.  The analysis of acquired capsule images requires a physician trained in endoscopy. **Plan on spending approximately one hour in the office at the time of your appointment to properly get the test initiated, and returning to the office 8 hours later to conclude the testing.** CONTRAINDICATIONS: Due to the possibility of radio frequency interference, or an increased risk of obstruction or capsule retention, patients with any one of the following conditions cannot undergo the examination: * Patients with a cardiac pacemaker, implanted cardiac defibrillator or other implanted electronic devices. * Patients with known intestinal strictures, adhesions, diverticulum, obstruction or fistulas that may block the passage of the capsule endoscope. * Patients with significant difficulty in swallowing a tablet as large as a capsule endoscope. * Patients with known swallowing disorders. * Patients who cannot undergo surgery to remove the capsule when retention of the capsule occurs. * Pregnant women. * Patients with known significant delay in the passing through of the capsule endoscope in the gastrointestinal tract. * Patients diagnosed with radiation enteritis. INSTRUCTIONS: * At 7:00 pm the night before your procedure, drink one 10-ounce bottle of Magnesium Citrate.  Magnesium Citrate is an over-the-counter product and is available at any drugstore. * You must abstain from eating or drinking 8 hours before the examination. * Do not take any medication the morning of your procedure.  You may take medications 2 hours after your procedure has started. * Avoid wearing a dress or a one-piece suit.  Wear a separate top and bottom so that the antenna lead cables can be connected to the recorder unit that is fitted to your waist. * Your body hair may need to be shaved in order to securely adhere the antenna leads. * Adhesive covers will be used to attach the antenna leads to your abdominal area (or back).  The antenna leads must not be removed for about 8 hours.  If you experience any discomfort (i.e. skin irritation or pain) while the antenna leads are attached, please inform the office. Your Capsule Endoscopy is scheduled for:

DATE: _______________________________ ARRIVAL TIME: ______________________

DURING YOUR CAPSULE ENDOSCOPY TESTING: * It is normal for the light to flash on the recording unit during the testing.  This indicates that images are being captured and transmitted to the recording unit. * The capsule endoscope contains metal parts.  While the capsule endoscope is in your body, stay away from equipment that generates strong magnetic fields (i.e. MRI equipment, amateur (Ham) radios, etc.).  Otherwise, you may injure your internal organs.  Do not use radio transmitting devices, such as keyless entry devices, or stay in an area where other persons may use them frequently on order to reduce the possibility of dropped video frames caused by the use of these devices. * Since the capsule endoscope contains a radio transmitter, you cannot fly in an airplane until the examination is completed. * If you experience stomach pain, discomfort, or nausea after ingesting the capsule endoscope, contact the office immediately. * Do not drink for 2 hours after ingesting the capsule endoscope.  Do not eat for 4 hours after ingesting the capsule endoscope.  After 4 hours, you may have a small, light meal. * If you will be receiving other medical treatments during the examination, consult your physician beforehand. * Reddening or irritation of the skin may sometimes be caused by the adhesive on the antenna lead covers.  If this is observed, contact the office immediately. * Do not operate the recording equipment.  Handle the equipment with care.  Please refer to the following instructions: * Do not remove the equipment from the harness * Do not operate the equipment switches * Do not bump or drop the equipment * Do not run or move wildly * Do not pull or bend the antenna lead cables * Do not wet the equipment with water or any other liquid * After about 8 hours, return to the office for the examination equipment to be removed. AFTER YOUR CAPSULE ENDOSCOPY TESTING: * The capsule endoscope contains metal parts.  While the capsule endoscope is in your body, stay away from equipment that prohibits the wearing of metallic objects in close proximity to it (i.e. MRI equipment).  Otherwise, you may injure your internal organs. * The capsule endoscope will be excreted naturally in your feces.  Please watch for the capsule endoscope in your feces. * If the capsule endoscope is not excreted within two weeks after the examination, consult your physician.  When excretion of the capsule endoscope is not confirmed, you may need to undergo an X-ray examination.  If the result of the X-ray shows retention of the capsule endoscope, it has to be retrieved by either a surgical operation or a conventional Endoscopic procedure within 30 days of ingestion.