Story last updated at 1:07 p.m. Thursday, September 19, 2002

A better pill to swallow

Homer surgeon tunes in to ultimate reality TV show

by Chris Bernard
Staff Writer

photo: news

  Photo by Chris Bernard, Homer News
Dr. Rene Alvarez holds the M2A capsule, which contains a camera used to photograph patients' intestinal tracts.  
At about $1,800 a pop, you don't want to take two of these pills and call your doctor in the morning. But taking just one of them could save your life.

"It basically gives us access to places we've not been able to go before without pretty invasive surgery. It fills in the gaps between an upper G.I. endoscopy and a colonoscopy."

<> Dr. Rene Alvarez,
SPH surgeon

Not a vitamin, medicine or herbal remedy, the "M2A" is actually a still camera covered in a digestible capsule. Once swallowed, it travels through your small intestine and sends back images, much like the Viking satellite did from Mars.

"It basically gives us access to places we've not been able to go before without pretty invasive surgery," said Dr. Rene Alvarez, a Homer general surgeon. "It fills in the gaps between an upper G.I. endoscopy and a colonoscopy, showing a 21-foot section of the small intestine."

Alvarez is the only doctor in Alaska performing the procedure.

Patients swallow the single-use camera in the morning. Throughout the day, they wear a belt, which carries a battery pack, a computer hard-drive and a transducer. Eight sensors attached to the body allow the system to track the camera's progress through the body.

The camera transmits two images per second to the hard drive, which records them. At the end of the day, the camera is passed painlessly in the patient's stool.

Alvarez then downloads the images -- about 50,000 of them -- to a computer, and watches the time-lapse voyage, looking for irregularities such as bleeding, ulcers, strictures or tumors.

Using the proprietary software, it takes Alvarez about 45 minutes to watch the footage of the camera's travel through the intestinal system. The computer automatically edits out periods of inactivity.

Onscreen, Alvarez sees a high resolution, near-video image of the intestine, as well as a map of the intestine with a representation of the camera pinpointing its location. He can isolate segments of the footage for closer inspection.

"You can pull out an image and better identify it on the tracking system to localize what you're seeing," he said. "It really opens doors for us, because in the past, patients would go to doctors with all these complaints about pain or bleeding, and they'd go essentially undiagnosed and get labeled as an irritable bowel."

Doctors would treat the mystery pain with painkillers, and often the problem would not go away, leaving invasive exploratory surgery as the only remaining option.

The nature of the images allow Alvarez to e-mail them to experts in the field anywhere in the world for consultation.

The camera itself is less than half an inch in diameter, and is easily swallowed.

"It's incredibly slippery when it's wet," Alvarerz said.

It consists of a tiny lens with a 140-degree field of view, two batteries, four LED flashes, an antenna and a transmitter.

The only risk associated with the procedure involves the camera getting stuck in the intestine, which happens about 1 percent of the time.

"If it gets stuck, that usually means there's something wrong, either a tightening or a stricture in the intestine, or a tumor," Alvarez said. "That would have to be operated on anyway."

The technology has been in the works for about 10 years, and was first put into practice after being approved by the federal Food and Drug Administration last year, said a spokesman for the manufacturer, Given Imaging. An Israeli scientist who designed imaging systems for missiles worked on the camera as a side project.

The procedure, called capsule endoscopy, has made national news in the past few years. A Givens Imaging promotional video shows clips from half-a-dozen major television news shows and interviews with several renowned doctors and patients who have undergone the procedure.

As one patient swallows the pill with a glass of water, the LEDs can be seen flashing from within her mouth.

Insurance covers the procedure in 24 states.

"The company has a whole team of people who help pursue insurance companies to pay for it," said Alvarez, who has 15 years of experience as a general surgeon in Alaska. "It's a new technology, and it's only going to improve."

Alvarez said that currently, capsule endoscopy is only performed after traditional scoping procedures have already been tried.

Early on the morning of Sept. 10, Alvarez watched as his first patient -- Homer Medical Center's Dr. Bill Bell -- swallowed the capsule and strapped on the belt.

"Going down wasn't a problem at all," Bell said later. "It went right down. It's pretty slippery, and it's not much bigger than a big B vitamin. The belt is getting a lot of questions here at the office, and occasionally I'll sit down and bump it."

Bell said he agreed to be a guinea pig because he's "interested in the extension of technology into medicine."

"The technology is pretty amazing," he said. "For the right clinical situation, from what I've experienced so far, I'd definitely recommend it."

Chris Bernard can be reached at cbernard@homernews.com.

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