Expired CME Article
Capsule Endoscopy: A Review
Abstract
Capsule endoscopy (CE) is a novel technology that allows direct noninvasive visualization of the entire small intestine. CE permits a detailed examination in the ambulatory setting, allowing identification of clinically relevant lesions, and it is appealing to both patients and providers. There are two types of capsules that are currently commercially available: one specifically designed to view the small bowel and the other for the esophagus. Common indications for small bowel CE include obscure gastrointestinal bleeding, initial diagnosis of suspected Crohn's disease, and other small bowel pathology. The esophageal capsule is currently used to evaluate Barrett esophagus and esophageal varices. It is a well-tolerated procedure with relatively few complications. Although CE performance may be superior to existing technologies, its impact on clinical decision-making and patient outcomes are of even greater importance. Herein lies a review of the latest information on CE, its indications, complications, future utilities, and developing technology.
Key Points
* Capsule endoscopy is a novel method of evaluating the small bowel and the esophagus.
* Capsule endoscopy is a relatively safe procedure with few complications and is well tolerated by patients.
* New indications are emerging regularly and the experience is growing rapidly.
This content is limited to qualifying members.
Existing members, please login first
If you have an existing account please login now to access this article or view purchase options.
Purchase only this article ($25)
Create a free account, then purchase this article to download or access it online for 24 hours.
Purchase an SMJ online subscription ($75)
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
Purchase a membership plan (fees vary)
Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.
References
1. Iddan G, Meron G, Glukhovsky A, et al. Wireless capsule endoscopy. Nature 2000;405:417.
2. Mishkin DS, Chuttani R, Croffie J, et al. ASGE Technology Status Evaluation Report: wireless capsule endoscopy. Gastrointest Endosc 2006;63:539–545.
3. Fleischer DE. Capsule endoscopy: the voyage is fantastic–will it change what we do? Gastrointest Endosc 2002;56:452–456.
4. Leighton JA, Sharma VK, Hentz JG, et al. Capsule endoscopy versus push enteroscopy for evaluation of obscure gastrointestinal bleeding with 1-year outcomes. Dig Dis Sci 2006;51:891–899.
5. Eliakim R, Fischer D, Suissa A, et al. Wireless capsule video endoscopy is a superior diagnostic tool in comparison to barium follow-through and computerized tomography in patients with suspected Crohn's disease. Eur J Gastroenterol Hepatol 2003;15:363–367.
6. Costamagna G, Shah SK, Riccioni ME, et al. A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Gastroenterology 2002;123:999–1005.
7. Eliakim R. The impact of wireless capsule endoscopy on gastrointestinal diseases. South Med J 2007;100:235–236.
8. Ramirez FC, Hakim S, Tharalson EM, et al. Feasibility and safety of string wireless capsule endoscopy in the diagnosis of esophageal varices. Am J Gastroenterol 2005;100:1065–1071.
9. Ramirez FC, Shaukat MS, Young MA, et al. Feasibility and safety of string, wireless capsule endoscopy in the diagnosis of Barrett esophagus. Gastrointest Endosc 2005;61:741–746.
10. Eliakim R, Fireman Z, Gralnek IM, et al. Evaluation of the PillCam Colon capsule in the detection of colonic pathology: results of the first multicenter, prospective, comparative study. Endoscopy 2006;38:963–970.
11. Spada C, Riccioni ME, Costamagna G. Rapid® access real-time device and rapid access software: new tools in the armamentarium of capsule endoscopy. Expert Rev Med Devices 2007;4:431–435.
12. Villa F, Signorelli C, Rondonotti E, et al. Preparations and prokinetics. Gastrointest Endosc Clin N Am 2006;16:211–220.
13. Dai N, Gubler C, Hengstler P, et al. Improved capsule endoscopy after bowel preparation. Gastrointest Endosc 2005;61:28–31.
14. Ben-Soussan E, Savoye G, Antonietti M, et al. Is a 2-liter PEG preparation useful before capsule endoscopy? J Clin Gastroenterol 2005;39:381–384.
15. Rey JF, Ladas S, Alhassani A, et al. European Society of Gastrointestinal Endoscopy (ESGE). Video capsule endoscopy: update to guidelines (May 2006). Endoscopy 2006;38:1047–1053.
16. Zuckerman GR, Prakash C, Askin MP, et al. AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 2000;118:201–221.
17. Hara AK, Leighton JA, Sharma VK, et al. Imaging of small bowel disease: comparison of capsule endoscopy, standard endoscopy, barium examination, and CT. Radiographics 2005;25:697–711; discussion 711–718.
18. Ell C, Remke S, May A, et al. The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding. Endoscopy 2002;34:685–689.
19. Mylonaki M, Fritscher-Ravens A, Swain P. Wireless capsule endoscopy: a comparison with push enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleeding. Gut 2003;52:1122–1126.
20. de Leusse A, Vahedi K, Edery J, et al. Capsule endoscopy or push enteroscopy for first-line exploration of obscure gastrointestinal bleeding? Gastroenterology 2007;132:855–862; quiz 1164–1165.
21. Carey EJ, Leighton JA, Heigh RI, et al. A single-center experience of 260 consecutive patients undergoing capsule endoscopy for obscure gastrointestinal bleeding. Am J Gastroenterol 2007;102:89–95.
22. Jones BH, Fleischer DE, Sharma VK, et al. Yield of repeat wireless video capsule endoscopy in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 2005;100:1058–1064.
23. Valle J, Alcantara M, Perez-Grueso MJ, et al. Clinical features of patients with negative results from traditional diagnostic work-up and Crohn's disease findings from capsule endoscopy. J Clin Gastroenterol 2006;40:692–696.
24. Van Tuyl SAC, Van Noorden JT, Kuipers EJ, et al. Results of videocapsule endoscopy in 250 patients with suspected small bowel pathology. Dig Dis Sci 2006;51:900–905.
25. Chong AK, Taylor A, Miller A, et al. Capsule endoscopy vs. push enteroscopy and enteroclysis in suspected small-bowel Crohn's disease. Gastrointest Endosc 2005;61:255–261.
26. Triester SL, Leighton JA, Leontiadis GI, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn's disease. Am J Gastroenterol 2006;101:954–964.
27. Hopper AD, Sidhu R, Hurlstone DP, et al. Capsule endoscopy: an alternative to duodenal biopsy for the recognition of villous atrophy in coeliac disease? Dig Liver Dis 2007;39:140–145.
28. Rondonotti E, de Franchis R. Diagnosing coeliac disease: is the videocapsule a suitable tool? Dig Liver Dis 2007;39:145–147.
29. Eswaran S, Rubin M, Green P. Capsule endoscopy can make the diagnosis of celiac disease when duodenal biopsy fails. Digestive Diseases Week. Washington D.C., 2007.
30. Rondonotti E, Spada C, Cave D, et al. Video capsule enteroscopy in the diagnosis of celiac disease: a multicenter study. Am J Gastroenterol 2007;102:1624–1631.
31. Cellier C, Green PH, Collin P, Murray J; ICCE. ICCE consensus for celiac disease. Endoscopy 2005;37:1055–1059.
32. Kesari A, Bobba RK, Arsura EL. Video capsule endoscopy and celiac disease.[see comment]. Gastrointest Endosc 2005;62:796–797.
33. Hara AK, Leighton JA, Sharma VK, et al. Small bowel: preliminary comparison of capsule endoscopy with barium study and CT. Radiology 2004;230:260–265.
34. Rondonotti E, Pennazio M; Italian Club for Capsule Endoscopy, European Capsule Endoscopy Group, Iberian Group of Capsule Endoscopy: Small Bowel Tumors Detected By Video Capsule Endoscopy (VCE): Preliminary Data from the ECEG (European Capsule Endoscopy Group) Database. Gastrointest Endosc 2007;65:AB90.
35. Neumann S, Schoppmeyer K, Lange T, et al. Wireless capsule endoscopy for diagnosis of acute intestinal graft-versus-host disease. Gastrointest Endosc 2007;65:403–409.
36. Burke CA, Santisi J, Church J, Levinthal G. The utility of capsule endoscopy small bowel surveillance in patients with polyposis. Am J Gastroenterol 2005;100(7):1498–1502.
37. Wong RF, Tuteja AK, Haslem DS, et al. Video capsule endoscopy compared with standard endoscopy for the evaluation of small-bowel polyps in persons with familial adenomatous polyposis (with video). Gastrointest Endosc 2006;64:530–537.
38. Eliakim R, Sharma VK, Yassin K, et al. A prospective study of the diagnostic accuracy of PillCam ESO esophageal capsule endoscopy versus conventional upper endoscopy in patients with chronic gastroesophageal reflux diseases. J Clin Gastroenterol 2005;39:572–578.
39. Sharma P, Wani S, Rastogi A, et al. The diagnostic accuracy of esophageal capsule endoscopy in patients with gastroesophageal reflux disease and Barrett esophagus: a blinded, prospective study. Am J Gastroenterol 2007 Apr 24; [epub ahead of print].
40. Eisen GM, Eliakim R, Zaman A, et al. The accuracy of PillCam ESO capsule endoscopy versus conventional upper endoscopy for the diagnosis of esophageal varices: a prospective three-center pilot study. Endoscopy 2006;38:31–35.
41. Cave D, Legnani P, de Franchis R, et al. ICCE consensus for capsule retention. Endoscopy 2005;37:1065–1067.
42. Cheifetz AS, Lewis BS. Capsule endoscopy retention: is it a complication? J Clin Gastroenterol 2006;40:688–691.
43. Fleischer D, Heigh R, Nguyen C, et al. Videocapsule impaction at the cricopharyngeus: a first report of this complication and its successful resolution. Gastrointest Endosc 2003;57:427–428.
44. Rondonotti E, Herrerias JM, Pennazio M, et al. Complications, limitations, and failures of capsule endoscopy: a review of 733 cases. Gastrointest Endosc 2005;62:712–716.
45. Pennazio M, Santucci R, Rondonotti E, et al. Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. Gastroenterology 2004;126:643–653.
46. Banerjee R, Bhargav P, Reddy P, et al. Safety and efficacy of the M2A patency capsule for diagnosis of critical intestinal patency: Results of a prospective clinical trial. J Gastroenterol Hepatol 2007;22:2060–2063.
47. Spada C, Spera G, Riccioni M, et al. A novel diagnostic tool for detecting functional patency of the small bowel: the Given patency capsule.[see comment]. Endoscopy 2005;37:793–800.
48. Spada C, Shah SK, Riccioni ME, et al. Video capsule endoscopy in patients with known or suspected small bowel stricture previously tested with the dissolving patency capsule. J Clin Gastroenterol 2007;41:576–582.
49. Gay G, Delvaux M, Laurent V, et al. Temporary intestinal occlusion induced by a “patency capsule” in a patient with Crohn's disease. Endoscopy 2005;37:174–177.
50. Leighton JA, Sharma VK, Srivathsan K, et al. Safety of capsule endoscopy in patients with pacemakers. Gastrointest Endosc 2004;59:567–569.
51. Leighton JA, Srivathsan K, Carey EJ, et al. Safety of wireless capsule endoscopy in patients with implantable cardiac defibrillators. Am J Gastroenterol 2005;100:1728–1731.
52. Dubner S, Dubner Y, Rubio H, et al. Electromagnetic interference from wireless video-capsule endoscopy on implantable cardioverter-defibrillators. Pacing Clin Electrophysiol 2007;30:472–475.
53. Chong AK, Chin BW, Meredith CG. Clinically significant small-bowel pathology identified by double-balloon enteroscopy but missed by capsule endoscopy. Gastrointest Endosc 2006;64:445–449.
54. Faigel DO, Baron TH, Adler DG, et al. ASGE guideline: guidelines for credentialing and granting privileges for capsule endoscopy. Gastrointest Endosc 2005;61:503–505.
