Colon capsule endoscopy

The ScotCap Test is a new procedure which is being introduced across NHS health boards in Scotland and is being used as an alternative to a colonoscopy. Your consultant will decide if its's appropriate for you and will depend on your symptoms and any previous investigations.

A colon capsule endoscopy is a painless procedure which uses a camera to examine the large bowel (colon). Your bowel takes away the waste your body does not need.

The large bowel is normally checked by a colonoscopy – this is done using a thin flexible tube with a camera on the end. The tube is inserted into your bottom and goes round the large bowel.

The ScotCap test is a capsule which you swallow, and it contains 2 tiny cameras inside. The cameras take pictures of the lining of the bowel to look for any problems or signs of disease. This test can be used instead of a colonoscopy.

Colon blue man
The large bowel, also know as the colon or large intestine.

Why would I have this test?

There are a number of reasons why you may need an examination of your large bowel (colon):

  • you've symptoms like a change in your bowel habit or blood in your stool (poo)
  • you need a test to check for bowel diseases which you may be at risk of developing
  • you've been referred for this test because you were unable to have a colonoscopy

Patients with pacemakers or internal electro-medical devices, or pregnant women should not have this test.

Before the test

For this test to work well your bowel needs to be very clean so the cameras get the best pictures.

For a few days before your test you will be asked to change your diet, and to have only the type of food and drinks which help soften your stools (poo).

You will need to take some strong laxatives on the day before your test and again on the morning of the test.

On the day of the test

You'll be asked to attend an appointment at a clinic close to your home. Your appointment will last around 30 minutes. There are no effects from the test which would stop you driving to or from the clinic.

A trained nurse will check you're ready to start the test. The nurse will fit you with a special belt and receiver which you can wear underneath your clothes. You'll be given the capsule to swallow. The receiver will capture the pictures of your bowel which are sent wirelessly from the capsule. You can then return home.

Swallowing capsule
The ScotCap capsule can be easily swallowed and contains two small cameras.

When you are back at home

You wear the belt and receiver at home during the whole test which lasts around 6 hours. Throughout the day of your test you'll be asked to take more laxatives which act as a “booster” to help move the capsule through your bowel.

The capsule will normally pass out of your bowel in the evening before you go to bed, and will just be flushed safely away down the toilet. At the clinic you'll have been given a suppository which can be used to help the capsule pass.

When the capsule has been passed, you can remove the belt and receiver and get back to normal activities.

Pillcam in transit
As you go about your day the capsule moves through the small intestine towards your colon.

After the test

The day after the test you'll be asked to return the belt and receiver to a local agreed drop off point. The pictures from your test are uploaded from your recorder once it is returned. These pictures are then made into a video which is looked at by a trained doctor.

The doctor sends a report of your test to a specialist doctor (usually in less than a week). Your hospital doctor will review this and discuss the results with you.

Sensor Belt
The capsule is flushed down the toilet and you return the belt and receiver which contains the recordings for a specialist to examine.

Further tests

Your consultant will decide whether you need another test based on your ScotCap report. For the majority of patients who have the ScotCap test, nothing will be found which leads them to have any further tests.

For patients who do need another test, this is usually because:

  • the capsule has found something that needs further investigation.
  • the bowel wasn't clean enough for the camera to record clear pictures.
  • the capsule didn't make it all the way around the large bowel before the battery ran out.

This further test may be a colonoscopy, or a shorter camera test called a flexible sigmoidoscopy. These tests are usually needed to either treat something found by the capsule or to take a sample from the lining of the bowel to get a diagnosis.

If you have either of these tests you will have to take more laxatives before you have the test. A follow up test may be done urgently depending on what is found on the ScotCap report.

Are there any risks or complications with the ScotCap test?

Most patients who decide to have a ScotCap test have no problems. If there's a problem, it's usually because of the laxatives you take before the test. The strong laxatives can cause a few patients to be sick and become dehydrated. If this does happen, you'll feel better once you stop taking the laxatives.

Complications related to the capsule itself are rare. A very small number of patients may have some difficulty swallowing the capsule, but you'll be asked about any issues with swallowing before you start your test.

What if the capsule doesn’t pass through the bowel at the end of the test?

It may just be delayed and this is nothing to worry about. The capsule might get stuck on a narrow section of the bowel, if this happens then that's usually an answer for why the test was needed.

The capsule very rarely causes any blockage which needs further treatment. Following the test, you can't have an MRI test unless the capsule has been passed. If there's any doubt about this, you might need an X-ray to show that the capsule has been passed.