How helpful is capsule endoscopy to surgeons？

Capsule endoscopy is a new technology that, for the first time, allows complete, non-invasive endoscopic imaging of the small bowel. The efficacy of capsule endoscopy in the diagnosis of suspected small bowel diseases has been established. Important applications for surgeons include observations of obscure gastrointestinal bleeding and small bowel neoplasms.     

Wireless capsule endoscopy for obscure small-bowel disorders: final results of the first pediatric controlled trial.

BACKGROUND AND AIMS: Obscure small-bowel disorders are jejunal and ileal lesions undiagnosed by traditional imaging techniques (endoscopic, radiologic). We evaluated the diagnostic usefulness and safety of capsule endoscopy for obscure small-bowel disorders in children and adolescents. METHODS: Comparative, prospective, self-controlled trials in patients (age, 10-18 y) suspected to have either small-bowel Crohn's disease, polyps, or obscure gastrointestinal (GI) bleeding. Capsule results were compared with the diagnostic imaging studies normally used in this age group. RESULTS: Among 20 patients suspected of Crohn's disease, multiple lesions consistent with this diagnosis were observed by capsule endoscopy in 50%. Small-bowel Crohn's disease was ruled out in 8 patients. Eosinophilic enteropathy was found in 2 others. For polyp detection (n = 6), capsule endoscopy yielded 100% concordance with the control studies when analyzed per patient. However, capsule endoscopy revealed a greater number (50%) of polyps. Among patients with obscure bleeding (n = 4), the capsule examination confirmed a diagnosis of vascular malformations in 3. Capsule endoscopy more accurately identified the precise source of bleeding compared with angiography. All 30 capsule studies were well tolerated, although 1 capsule was retained owing to an inflammatory stenosis. The capsule eventually was expelled after corticosteroid therapy. CONCLUSIONS: Capsule endoscopy correctly diagnosed or excluded a bleeding source, small-bowel polyps, or Crohn's disease of the small bowel in 29 of 30 patients. Capsule endoscopy permits an accurate, noninvasive approach for diagnosing obscure small bowel lesions in children over the age of 10.     

Capsule endoscopy retention: is it a complication?

BACKGROUND: Capsule endoscopy has been found superior to barium x-rays and push enteroscopy in the investigation of obscure gastrointestinal bleeding and in the evaluation of suspected Crohn's disease. Currently, small bowel obstruction and strictures are considered by many physicians to be a contraindication to capsule endoscopy for fear of capsule retention or impaction. The goal of this study was to reassess this conventional wisdom that capsule endoscopy is contraindicated in small bowel obstruction and to determine the safety and efficacy of capsule endoscopy in the evaluation of patients with suspected stricture or small bowel obstruction. STUDY: A retrospective chart review was performed using a database of 568 capsule endoscopy cases performed between August 2001 and November 2003. Cases of suspected small bowel obstruction were selected and reviewed. RESULTS: Nineteen cases were identified in which capsule endoscopy was used in the setting of suspected small bowel obstruction. The diagnosis of suspected small bowel obstruction was based on symptoms alone in 8 cases and on symptoms plus abnormal radiographs in the remaining 11 cases. Capsule endoscopy made a definitive diagnosis in 5 of the 19 cases (26%): 2 Crohn's strictures, 1 radiation induced stricture, 1 nonsteroidal anti-inflammatory drug induced stricture, and 1 MALT lymphoma. The capsule was retained proximal to a stricture in 4 cases, in which the obstructing lesions were electively resected without complications. There was no case in which administration of the capsule led to an acute small bowel obstruction. CONCLUSIONS: Capsule endoscopy can be safely used to help identify the etiology and site of a small bowel obstruction. Retention of the capsule may indicate the presence of a lesion requiring surgery, but small bowel obstruction or strictures are not in themselves contraindications to the procedure. It is understood, however, that retention may lead to surgery in a patient who otherwise may have been treated medically without surgery for the same illness (eg, Crohn's disease and nonsteroidal anti-inflammatory drug enteropathy).     

Clinical utility, safety and tolerability of capsule endoscopy in urban Southeast Asian population

AIM: Capsule endoscopy has demonstrated its clinical utility in the evaluation of small bowel pathology in several Western studies. In this prospective study, we aimed to determine the clinical utility, safety and tolerability of capsule endoscopy in the evaluation of suspected small bowel disease in an urban Southeast Asian population.METHODS: We used the given (M2A) capsule endoscopy system in 16 consecutive patients with suspected small bowel pathology. In 9 patients the indication was obscure gastrointestinal bleeding, while in 6 patients it was to determine the extent of small bowel involvement in Crohn‘s disease. One patient underwent capsule endoscopy for evaluation of chronic abdominal pain. Patient‘‘s tolerabilityto the procedure was evaluated by standardized questionnaires and all patients were reviewed at one week to ensure that the capsule had been excreted without any adverse events.RESULTS: Abnormal findings were present in 8 patients (50 %). The cause of obscure gastrointestinal bleeding was determined in 5 out of 9 patients. Findings included 2 cases of angiodysplasia, 2 cases of jejunal ulcers and 1 case of both angiodysplasia and jejunal ulcer. One patient had smallbowel erosions and foci of erythema of doubtful significance. Ileal lesions were diagnosed in 2 out of 6 patients with Crohn‘‘s disease. Capsule endoscopy was well tolerated by allpatients. One patient with Crohn‘‘s disease had a complication of capsule retention due to terminal ileum stricture. Thecapsule eventually passed out spontaneously after 1 month. CONCLUSION: Our study, which represented the first Asian series, further confirms the diagnostic utility, safety and tolerability of wireless capsule endoscopy.     

Capsule endoscopy in the pediatric patient

Wireless capsule endoscopy represents an extraordinary technical innovation in diagnostic gastrointestinal endoscopy. As in adult patients, it opens new horizons that permit an accurate and noninvasive approach to identifying occult lesions in the small bowel in children and adolescents. A limitation in the pediatric age group is the size of the capsule, precluding its use in infants and small toddlers. In children unable to swallow the capsule, “front loading” the gastroscope to introduce it into the duodenum is a suitable alternative approach. Capsule endoscopy is highly useful to evaluate for inflammatory changes in patients suspected to have small bowel Crohn’s disease in whom conventional imaging failed to confirm the diagnosis. It is now the method of first choice to assess for small bowel polyps or tumors, to find a source of blood loss in obscure intestinal bleeding, and for undiagnosed malabsorptive conditions such as intestinal lymphangiectasia. Capsule retention is the one major potential adverse effect of capsule endoscopy. In patients suspected to have a small bowel stenosis, consideration should be given to using the patency capsule prior to using the real videocapsule so as to decrease the risk of capsule retention.     

Video capsule endoscopy of the small bowel.

PURPOSE OF REVIEW: It is now more than 6 years since capsule endoscopy was first introduced to the gastroenterological community. This disposable 26 x 11 mm video capsule, containing its own optical dome, light source, batteries, transmitter and antenna, is swallowed with water after a 12 h fast. The capsule is propelled via peristalsis through the gastrointestinal tract, capturing about 60 000 digital images, and is excreted naturally. Capsule endoscopy has become a first-line tool for detecting abnormalities in the small bowel, because all other imaging technologies are rather ineffective. This review covers recent developments in capsule endoscopy technology and provides an update of its main indications. RECENT FINDINGS: There are some clear indications for capsule endoscopy: obscure gastrointestinal bleeding, suspected small bowel tumour (in which it is becoming a primary investigational tool), suspected Crohn's disease, surveillance of inherited polyposis syndromes, drug-induced small bowel injury, and any abnormal small bowel imaging. Controversy persists regarding what is a normal small bowel appearance, which is exacerbated by the inability to take biopsies and thus differentiate between entities; with technological advances, however, it is hoped that this will be addressed. SUMMARY: Capsule endoscopy has been incorporated into the gastroenterologists' daily life, changing the approach to many small bowel pathologies.     

Wireless capsule video endoscopy：Three years of experience

AIM:To review and summerize the current literatue regarding M2A wireless capsule endoscopy.METHODS:Peer reviewed publications regarding the use of capsule endoscopy as well as our personal experience were reviewed.RESULTS:Review of the literature dearly showed that capsule endoscopy was superior th enteroscopy,small bowel follow through and computerized tomography in aptients with obscure qastrointestinal bleeding,iron deficiency anemia,or suspected Crohn‘s disease.It was very sensitive for the diagnosis of small bowel tumors and for survailance of small bowel pathology in patients with Gardner syndrome or familial adenomatous polyposeis syndrome.Its role in celiac disease and in patients with kmown Crohn‘s disease was currently being investigated.CONGLUSION:Capsule video endoscopy is a superior and more sensitive diagnostic tool than barium follow through,enteroscopy and entero-CT in establishing the diagnosis of many small bowel pathologyes.     

Capsule endoscopy： Current status in obscure gastrointestinal bleeding

Capsule endoscopy (CE) is a safe, non invasive diagnostic modality for the evaluation of small bowel lesions. Obscure gastrointestinal bleeding (OGIB) is one of the most important indications of capsule endoscopy. Capsule endoscopy has a very high diagnostic yield especially if the bleeding is ongoing. This technique appears to be superior to other techniques for the detection of suspected lesions and the source of bleeding. Capsule endoscopy has been shown to change the outcome in patients with obscure gastrointestinal (GI) bleed.     

Capsule endoscopy:Current practice and future directions

Capsule endoscopy(CE)has transformed investigation of the small bowel providing a non-invasive,well tolerated means of accurately visualising the distal duodenum,jejunum and ileum.Since the introduction of small bowel CE thirteen years ago a high volume of literature on indications,diagnostic yields and safety profile has been presented.Inclusion in national and international guidelines has placed small bowel capsule endoscopy at the forefront of investigation into suspected diseases of the small bowel.Most commonly,small bowel CE is used in patients with suspected bleeding or to identify evidence of active Crohn’s disease(CD)(in patients with or without a prior history of CD).Typically,CE is undertaken after upper and lower gastrointestinal flexible endoscopy has failed to identify a diagnosis.Small bowel radiology or a patency capsule test should be considered prior to CE in those at high risk of strictures(such as patients known to have CD or presenting with obstructive symptoms)to reduce the risk of capsule retention.CE also has a role in patients with coeliac disease,suspected small bowel tumours and other small bowel disorders.Since the advent of small bowel CE,dedicated oesophageal and colon capsule endoscopes have expanded the fields of application to include the investigation of upper and lower gastrointestinal disorders.Oesophageal CE may be used to diagnose oesophagitis,Barrett’s oesophagus and varices but reliability in identifying gastroduodenal pathology is unknown and it does not have biopsy capability.Colon CE provides an alternative to conventional colonoscopy for symptomatic patients,while a possible role in colorectal cancer screening is a fascinating prospect.Current research is already addressing the possibility of controlling capsule movement and developing capsules which allow tissue sampling and the administration of therapy.     

Diagnosing small bowel Crohn's disease with wireless capsule endoscopy

BACKGROUND: The small bowel is the most commonly affected site of Crohn's disease (CD) although it may involve any part of the gastrointestinal tract. The current methodologies for examining the small bowel are x ray and endoscopy. AIMS: To evaluate, for the first time, the effectiveness of wireless capsule endoscopy in patients with suspected CD of the small bowel undetected by conventional modalities, and to determine the diagnostic yield of the M2A Given Capsule. PATIENTS: Seventeen patients (eight males, mean age 40 (15) years) with suspected CD fulfilled study entry criteria: nine had iron deficiency anaemia (mean haemoglobin 10.5 (SD 1.8) g%), eight had abdominal pain, seven had diarrhoea, and three had weight loss. Small bowel x ray and upper and lower gastrointestinal endoscopic findings were normal. Mean duration of symptoms before diagnosis was 6.3 (SD 2.2) years. METHODS: Each subject swallowed an M2A Given Capsule containing a miniature video camera, batteries, a transmitter, and an antenna. Recording time was approximately eight hours. The capsule was excreted naturally in the patient's bowel movement, and the data it contained were retrieved and interpreted the next day. RESULTS: Of the 17 study participants, 12 (70.6%, six males, mean age 34.5 (12) years) were diagnosed as having CD of the small bowel according to the findings of the M2A Given Capsule. CONCLUSIONS: Wireless capsule endoscopy diagnosed CD of the small bowel (diagnostic yield of 71%). It was demonstrated as being an effective modality for diagnosing patients with suspected CD undetected by conventional diagnostic methodologies.     

A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease

BACKGROUND & AIMS: This study was undertaken to prospectively compare the clinical outcomes of small bowel radiographs with the wireless capsule endoscopy. METHODS: Twenty-two patients were selected consecutively because of suspected small bowel disease. Two patients were excluded owing to ileal stenosis. Thus, the results of barium follow-through and the Given M2A wireless video capsule (Given Imaging Ltd., Yoqneam, Israel) endoscopy were compared in 20 patients (13 men; mean age, 52.5 yr; range, 29-78 yr). RESULTS: Barium follow-through was normal in 17 patients and showed ileal nodularity in 3 patients. Capsule endoscopy was normal in 3 patients and showed positive findings in the remaining 17 patients. The barium study was considered diagnostic in 4 (20%) patients. The capsule endoscopy was considered diagnostic in 9 (45%) patients, suspicious in 8 (40%) patients, and failed in 3 (15%) patients. For obscure gastrointestinal (GI) bleeding, the diagnostic potential of barium follow-through was much worse as compared with the capsule endoscopy (5% vs. 31%, P < 0.05). Capsule endoscopy was well tolerated and better accepted by patients when compared with the most recently performed endoscopic procedure. CONCLUSIONS: The video capsule endoscope was found to be superior to small bowel radiograph for evaluation of small bowel diseases. However, this novel wireless endoscope system needs further assessment because of limitations such as difficulties in interpretation of potentially nonspecific findings.     

Capsule endoscopy and Crohn's disease

Capsule endoscopy has been shown to detect small bowel inflammatory changes better than any other imaging modality. Selection criteria have been optimized to increase the yield of capsule endoscopy in patients suspected of having Crohn's disease. Capsule endoscopy allows for earlier diagnosis of Crohn's disease of the small bowel and improved diagnosis of colitis in patients where it is unclear if they suffer from Crohn's or ulcerative colitis. A test capsule is available to assess for small bowel strictures and thus avoid capsule retention. It is envisioned that the manner in which we treat Crohn's disease in the future will change, based on earlier diagnosis and treatment aimed at mucosal healing rather than symptom improvement.     

Capsule endoscopic features of Crohn's disease

Background: Crohn's disease (CD) is becoming increasingly recognized in Indian patients. As this disease often affects the small bowel, capsule endoscopy can help diagnose this disease and add valuable information regarding the extent of the disease. Our aim is to report our experience with the wireless capsule endoscope in patients with either known or suspected CD. Methods: Patients referred for capsule endoscopy with known or suspected CD were studied. All patients underwent precapsule endoscopy colonoscopy and small bowel series examination. After an overnight fast and bowel preparation, the capsule was ingested and the data were recorded for 8 h on the external recording device. A gastroenterologist experienced in reading capsule endoscopy interpreted images. Results: Eleven patients (mean age 42 years [range 14–70], 7 males) underwent capsule examination. Seven patients had symptoms suggestive of CD with no precapsule evidence of the disease, one had suspected small bowel pseudo‐obstruction and three had known CD. All patients had lesions in the small intestine consistent with CD. Two patients had strictures that led to a retained capsule, despite precapsule small bowel series. Conclusions: Capsule endoscopy is emerging as a small bowel imaging modality that can greatly assist in making the diagnosis of CD. Small bowel radiology is unreliable in excluding strictures that may cause capsule retention.     

Capsule endoscopy regional transit abnormality: a sign of underlying small bowel pathology

BACKGROUND: Wireless capsule endoscopy is being used increasingly to investigate GI bleeding of obscure etiology and other small bowel abnormalities. Currently, there is no standard for capsule endoscopy image interpretation and classification METHODS: This report describes an abnormality, termed "regional transit abnormality," noted during a review of capsule endoscopic images. Capsule regional transit abnormality simply refers to delayed capsule transit within a segment of small bowel, with or without visualization of a mucosal abnormality. The slowed transit usually is accompanied by mucosal collapse, sometimes with the appearance of the capsule pressing or impacting upon the mucosa. Regional transit abnormality usually persists more than 15 minutes CONCLUSIONS: Capsule regional transit abnormality is considered to be a "red flag" sign that indicates a likelihood of some underlying small bowel pathology.     

Expanding role of capsule endoscopy in inflammatory bowel disease

Capsule endoscopy has been shown to detect small bowel inflammatory changes better than any other imaging modality. Selection criteria have been optimized to increase the yield of capsule endoscopy in patients suspected to have Crohn＇s disease. Capsule endoscopy allows for earlier diagnosis of Crohn＇s disease of the small bowel and improved diagnosis of colitis in patients where it is unclear if they suffer from Crohn＇s or ulcerative colitis. A test capsule is available to assess for small bowel strictures and thus avoid capsule retention. A common language has been developed and a new scoring index will be added to capsule software. It is envisioned that the manner in which we treat Crohn＇s disease in the future will change, based on earlier diagnosis and treatment aimed at mucosal healing rather than symptom improvement.     

What we have learned and what to expect from capsule endoscopy

Capsule endoscopy was conceived by Gabriel Iddan and Paul Swain independently two decades ago. These applications include but are not limited to Crohn’s disease of the small bowel, occult gastrointestinal bleeding, non steroidal anti inflammatory drug induced smallbowel disease, carcinoid tumors of the small bowel,gastro intestinal stromal tumors of the small bowel andother disease affecting the small bowel. Capsule endoscopy has been compared to traditional small bowelseries, computerized tomography studies and pushenteroscopy. The diagnostic yield of capsule endoscopyhas consistently been superior in the diagnosis of smallbowel disease compared to the competing methods(small bowel series, computerized tomography, pushenteroscopy) of diagnosis. For this reason capsule en-doscopy has enjoyed a meteoric success. Image qualityhas been improved with increased number of pixels,automatic light exposure adaptation and wider angle ofview. Further applications of capsule endoscopy of other areas of the digestive tract are being explored. Theincreased transmission rate of images per second hasmade capsule endoscopy of the esophagus a realisticpossibility. Technological advances that include a double imager capsule with a nearly panoramic view of the colon and a variable frame rate adjusted to the movement of the capsule in the colon have made capsuleendoscopy of the colon feasible. The diagnostic ratefor the identification of patients with polyps equal to orlarger than 6 mm is high. Future advances in technology and biotechnology will lead to further progress.Capsule endoscopy is following the successful moderntrend in medicine that replaces invasive tests with lessinvasive methodology.     

胶囊内镜在小肠疾病诊断中的作用

目的:小肠疾病很难诊断,现有的诊断技术又不尽如人意,而胶囊内镜能发现整个小肠内的微小病变。为此,我们对胶囊内镜在小肠疾病诊断中的价值进行评估。方法:自2002年5月至2003年9月,我们对经结肠镜、胃镜、X线钡餐造影、小肠钡灌造影、血管造影或核素扫描等检查未发现异常的79例疑患小肠疾病、尤其是不明原因消化道出血的患者,进行胶囊内镜检查,其中不明原因的消化道出血患者56例。结果:75例完成最终研究。75例患者中经胶囊内镜检查共发现异常63例,检出率为84％;其中能明确解释临床病因者50例,诊断率为66.6％,包括消化道血管病变21例、小肠炎症性肠病16例、小肠息肉5例、小肠恶性间质肿瘤2例、小肠类癌1例(该患者同时伴升结肠脂肪瘤)、淋巴瘤1例、粘膜下肿瘤3例及憩室1例。所获取的图像质量良好。结论:胶囊内镜对小肠疾病尤其是不明原因消化道出血具有良好的诊断价值。     

Cápsula endoscópica para el estudio de patologías de intestino delgado: experiencia en una institución privada en México

Introduction and aimsCapsule endoscopy has revolutionized the study of small bowel disorders. Its diagnostic yield, reasons for referral, and frequency of significant endoscopic findings at our institution are unknown. The aims of our study were to describe the reasons for referral, the frequency of significant endoscopic findings, and the diagnostic yield of capsule endoscopy in patients that underwent the procedure for the study of small bowel disorders.Material and methodsA retrospective study was conducted that included all patients that underwent capsule endoscopy for small bowel disorder evaluation at our institution. The diagnostic yield for significant endoscopic findings, the frequency of significant endoscopic findings, and the reasons for referral for capsule endoscopy were determined.ResultsA total of 134 patients were included in the study and 143 capsule endoscopies were performed. Women made up 48.5% of the sample and the mean patient age was 63 years (18.7 standard deviation). The main reasons for referral were suspicion of overt small bowel bleeding (55.9%) and suspicion of occult small bowel bleeding (28.6%). The overall diagnostic yield was 66.4%. The most common significant findings were small bowel angioectasias (52.6%) and small bowel ulcers (38.9%). There were two adverse events (1.3%): one capsule retention that required enteroscopic removal and one asymptomatic bronchoaspiration of the capsule that resolved spontaneously.ConclusionsThe frequency of significant endoscopic findings with capsule endoscopy at our institution was different from that reported in other Mexican studies, but the reasons for referral and the diagnostic yield were similar.     

Utility of Capsule Endoscopy for the Classification of Crohn's Disease: A Multicenter Study in Korea

Capsule endoscopy can detect lesions associated with Crohn's disease in the small bowel that go unrecognized by conventional radiologic imaging. The aim of this study was to assess the value of capsule endoscopy in the classification of patients with Crohn's disease. This study was carried out on 52 patients with known Crohn's disease. Small bowel follow-through findings were compared with capsule endoscopic findings. All patients were classified according to the extent of the disease: small bowel-colon type, small bowel type, or colon type. Seventeen patients who were reported as being normal showed evidence of small bowel Crohn's disease according to capsule endoscopy. Differences were observed between the small bowel follow-through and the capsule endoscopy classification (kappa=0.54). Treatment was changed based on the results of wireless capsule endoscopy in 15 patients.     

Capsule endoscopy in 2005: facts and perspectives

Capsule endoscopy has recently been introduced to explore endoscopically the whole small intestine, fulfilling a gap between examinations of the upper and lower gastrointestinal tract. The technique consists of a miniaturized endoscope, embedded in a swallowable capsule that is propulsed by peristalsis and achieves the journey to the right colon in five to eight hours. Images captured by the capsule are recorded on a hard drive worn in a belt by the patient. The main indication for capsule examination is the examination of the small bowel to find a bleeding lesion in patients with obscure bleeding. Several studies have shown that the diagnostic yield of capsule endoscopy is superior to that of push enteroscopy in this indication. Other possible indications are patients with suspected intestinal location of Crohn's disease, familial adenomatous polyposis, complicated coeliac disease and lesions due NSAIDs. The review contains information on the technical aspects of capsule endoscopy and discusses the indications. Issues of safety and tolerance are also discussed.