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Stanford researchers are the first in the Bay Area to test an ingestible, pill-sized camera that detects bleeding in the small intestine. This device, developed by Israel-based Given Imaging, Ltd., gives doctors their only glimpse inside the deepest parts of this hard-to-view organ without invasive surgery.

Jacques Van Dam, professor of medicine, recently used the miniature camera on his second medical center patient. The first two patients were part of a 10-clinic trial testing the device - called the M2A capsule - in people who need regular transfusions due to bleeding.

A second trial taking place at Stanford is for anemic patients who do not yet need transfusions. Doctors suspect internal bleeding when patients have consistently low levels of hemoglobin (the bloodborne protein that carries oxygen). "Usually the bleeding is in the stomach or colon," Van Dam said. "But sometimes we can't find the source." Often these patients must get regular transfusions to make up for the lost blood.

To detect bleeding in the throat, stomach or colon, doctors use endoscopy - a camera on the end of a long, flexible rod. But sometimes, endoscopy fails to show the source of bleeding, often leading doctors to suspect the small intestine. With no device for viewing inside the small intestine, however, exploratory surgery is the only way to know for sure Ð no small feat, given the 20-foot length of the organ. "[The M2A capsule] lets us see what's happening in the small intestine for the first time," Van Dam said.

In preparation for the procedure, a patient fasts for eight hours to prevent food in the small intestine from covering up trouble spots. The patient then swallows the vitamin-sized capsule which has four tiny flashing lights at one end, surrounding a color camera; it also contains a battery and an antenna. Receivers taped to the abdomen track the capsule's progress, recording two images per second as it works through the small intestines. The capsule transmits images via radio frequencies to a Walkman-sized device worn on a belt, along with a battery pack. Stanford's second patient to use the device, Leland McGraw, 77, who requires regular transfusions, swallowed the camera without a hitch. "I didn't feel it," he said, adding that the receivers and belt were comfortable.

Two hours after swallowing the M2A capsule, patients can drink clear liquids; at four hours, they can eat solid food. The patients can go about their daily business during the eight-hour procedure as long they don't dislodge the receivers or interfere with the battery pack and recorder. Eight hours after swallowing, the patient removes the belt and sensors, and forgets about the small plastic camera. "Patients don't have to retrieve the camera," said Van Dam. It simply completes its path through the digestive tract and is passed in stool.

The next day, the patient returns the belt, battery pack and recorder to the doctor, who downloads the video images into a computer. Software lets the doctor view the entire video of the camera's travels and save selected images. Doctors may be able to spot tumors, ulcers and bleeding. "More often than not, it's bleeding that we find," said Van Dam. Upon identifying the source, a surgeon can then remove the damaged portion of small intestine.

Although the capsule's individual components are based on existing technology, nobody has ever sent a camera through a person's digestive tract. "The fact that it worked is a big breakthrough," Van Dam said. "There's never been anything like this." Not only does it traverse the highly acidic stomach, the camera successfully peers through the soupy contents of the small intestine and takes pictures as it tumbles along.