There are many diseases of our gastrointestinal tract. Those that exist in the esophagus, stomach or proximal 2-3 feet of our small intestine are typically evaluated with upper endoscopy. Those that exist in our colon are typically evaluated with colonoscopy. There is around 18-22 feet of small intestine in between and it is very difficult to reach this with a traditional scope. There are radiographic studies that give us shadows and images of the small intestine and some of these do this relatively well.

However, the best way to fully evaluate diseases of the small intestine is to look at it directly with a small bowel capsule endoscopy. At my practice, I utilized the Given Imaging PillCam System to accomplish this. Basically, it is a fully contained camera, power and light source in a package about the size of a large medication tablet. This is swallowed and it travels through the entire length of your gastrointestinal tract taking about 50,000 images as it goes.  This makes the equivalent of a high-definition video of your small intestine.  It sends the images by radio waves to a small receiver you wear on your waist.  It is then passed naturally in your stool and can be flushed down the toilet (I don’t want it back).

This allows me to visualize the inside of your small intestine and make diagnosis and treatment recommendations. I have been doing small bowel capsule endoscopy since it got here to the United States in the early 2000’s and I frequently travel around the country giving lectures and teaching courses on this procedure at other institutions.


There are multiple conditions of the small intestine that are difficult to diagnose because of our limited ability to visualize this part of the gastrointestinal tract. Small bowel capsule endoscopy makes it possible to directly visualize this area. It is done to evaluate conditions like unexplained anemia, abdominal pain with diarrhea, and blood in the stool without a source found on upper endoscopy or colonoscopy. It is also frequently done in the diagnosis of Crohn’s disease and monitoring of management in Crohn’s disease.  We also use it to locate small bowel cancers.

Russell Dean Havranek, M.D. uses the Given Imaging PillCam SB video capsule when performing Capsule Endoscopy procedures in San Antonio TX. To learn more about how the Given Imaging PillCam SB works watch the video below or visit their website at https://www.givenimaging.com.


Capsule Endoscopy is a procedure that is covered by most insurance plans. However, as insurance coverage varies, it is suggested that you verify coverage with your insurance provider. If you or your insurance provider should need any clarification from Dr. Havranek’s office, please contact us at 210-615-8308.


Scheduling small bowel capsule endoscopy with my office is easy. No prior office visit is required. There are several ways to accomplish this. You can speak to your primary care physician and have them send us a request form and my office will contact you to make the arrangements. Another option is to call my office directly at 210-615-8308 and we will talk you through the process over the phone and help to make all arrangements. Another way is by clicking the “request an appointment” link below and filling in the appropriate information. My office will contact you to make the arrangements. We will also help you deal with and answer all questions regarding your insurance coverage.

request an appointment button with Dr. Havranek


One of the most important aspects of small bowel capsule endoscopy is the preparation to obtain a clean small bowel. Unlikely during traditional upper endoscopy or colonoscopy where I can suction through the scope, I cannot with the PillCam.  If there is dark fluid or debris still present in the small intestine during your exam, I cannot do anything about it, and it may cover lesions we need to see.  Therefore, I encouraged you to do the best you can to get a good clean small bowel.

The day before the exam I ask you to begin a liquid diet and avoid things that are red, green or dark blue in color.  Eat nothing solid.  I then have you buy the medium-sized bottle of over-the-counter MiraLax.  You will put half of the powder in one 20 ounce or larger glass of water and the other half into a second 20 ounce or larger glass of water. One of those glasses of water and MiraLax you will drink about 2 hours before bed the night before your exam. The second glass you will drink about 2 hours before you show up for your exam the next morning.

You are allowed to drink as much water as you would like before, during and after this process and I encouraged you to do so as staying well hydrated helps with this exam. You do not need to hold any of your blood thinner or aspirin-like medications. I do ask that you avoid iron tablets for 5-7 days before the exam as they can make the lining of the small bowel dark and difficult to see through.


Once you arrive at our office the day of the exam my medical assistant will take you into one of the exam rooms. There she will go over everything with you in detail and I will be available to answer any further questions that you may have. You will then have a small receiver put around your waist in a pouch. Then, with a glass of water, you will swallow the PillCam. This process takes about 15-20 minutes. You are then free to leave the office.

We allow about 8 hours for the PillCam to travel through your small bowel and take the needed images. During this eight-hour time period I ask that you refrain from strenuous physical activity. You are allowed to return to work. About 4 hours after ingesting the PillCam you will be allowed to eat a light lunch. You will then return to our office around 4:00 or 5:00 in the afternoon and the receiver pack will be removed. The camera of will pass on its own in your stool likely within the next day or so. The images from the receiver pack will be downloaded into a computer at our office and I will evaluate them and get a report out to both you and your physician.


Small bowel capsule endoscopy is a very safe procedure. Having said that, there are always potential risks and complications during any medical procedure. One of the potential risks of this procedure is interference with things like pacemakers. If you have any type of implantable electromagnetic device in your body, like a pacemaker or TENS unit, please notify my staff and we can instruct you on how to proceed.

One of the other possible complications is retention of the PillCam.  This can happen if it gets stuck behind a tumor or stricture. Sometimes this requires surgery and sometimes it can be retrieved with an upper endoscope or colonoscope. However, if it does get stuck behind a lesion in your bowel, this is usually the area of pathology that is causing your symptoms.  That area of pathology can then be treated surgically during removal of the camera.

If you have Crohn’s disease your risk for camera retention may be a higher. For patients with a known history of Crohn’s this risk is anywhere from 1-4%. Due to this risk, there is a dissolved patency capsule that can be ingested to help confirm if your small bowel is patent prior to swallowing the PillCam. If you have Crohn’s or there is a concern of possible PillCam retention please let my office know and we can arrange the patency capsule ahead of time.