Review Article

Small Bowel Capsule Endoscopy: A Systematic Review

Authors: Sumeeta Mazzarolo, MD, Patrick Brady, MD


Wireless capsule endoscopy offers a revolutionary diagnostic tool for small bowel diseases. Since its formal introduction, it has become an integral part of the diagnostic evaluation for obscure gastrointestinal bleeding. This relatively noninvasive imaging modality offered by small bowel capsule endoscopy is appealing to both patients and providers and consequently, the desire to expand its diagnostic role continues to grow. The use of CE in the diagnosis of Crohn disease and chronic diarrhea is being further investigated, as is the potential of employing this technique as a cancer surveillance mechanism in patients with hereditary polyposis syndromes which may involve the small bowel. This review article discusses the current indications for small bowel capsule endoscopy, the results of capsule endoscopy in patients with obscure gastrointestinal bleeding and small bowel diseases, and patient outcomes following capsule endoscopy. Capsule endoscopy is compared with traditional diagnostic modalities, including small bowel series, enteroclysis, CT, and push enteroscopy. Small bowel capsule endoscopy is the procedure of choice to evaluate obscure gastrointestinal bleeding, and is superior to radiographic procedures in detecting Crohn disease of the small bowel.

Key Points

* The use of capsule endoscopy (CE) is indicated in the diagnosis of obscure gastrointestinal bleeding.

* Multiple studies have demonstrated CE to have a higher diagnostic yield for the detection of obscure GI bleeding than conventional diagnostic modalities including enteroscopy and barium studies. The highest diagnostic yield of CE is in patients with ongoing bleeding or those with a continued positive fecal occult blood test and iron-deficiency anemia.

* Contraindications to CE include the presence of intestinal obstruction, fistulas or strictures that may impede the excretion of the capsule and can potentially cause a bowel obstruction.

* CE should be performed early on in the workup for patients with obscure GI bleeding following a negative upper and lower endoscopy.

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