Small bowel capsule endoscopy in 2007: Indications, risks and limitations

Abstract

Capsule endoscopy has revoluzionized the study of the small bowel by providing a reliable method to evaluate, endoscopically, the entire small bowel. In the last six years several papers have been published exploring the possible role of this examination in different clinical conditions. At the present time capsule endoscopy is generally recommended as a third examination, after negative bidirectional endoscopy, in patients with obscure gastrointestinal bleeding. A growing body of evidence suggests also an important role for this examination in other clinical conditions such as Crohn's disease, celiac disease, small bowel polyposis syndromes or small bowel tumors. The main complication of this examination is the retention of the device at the site of a previously unknown small bowel stricture. However there are also some other open issues mainly due to technical limitations of this tool (which is not driven from remote control, is unable to take biopsies, to insufflate air, to suck fluids or debris and sometimes to correctly size and locate lesions).The recently developed double balloon enteroscope, owing to its capability to explore a large part of the small bowel and to take targeted biopsies, although being invasive and time consuming, can overcome some limitations of capsule endoscopy. At the present time, in the majority of clinical conditions (i.e. obscure GI bleeding), the winning strategy seems to be to couple these two techniques to explore the small bowel in a painless, safe and complete way (with capsule endoscopy) and to define and treat the lesions identified (with double balloon enteroscopy).

Diagnosis and Management of Non-Variceal Gastrointestinal Hemorrhage: A Review of Current Guidelines and Future Perspectives

“…The overall diagnostic yield of VCE is 35-77%; the yield is higher among those who are inpatient, earlier VCE (within 2 weeks, greatest yield between 48 to 72 h of a bleeding episode), overt bleeding with transfusion requirement, Hgb <10 g/dL, longer duration of bleeding (>6 months), male sex, increasing age, liver, cardiac and renal comorbidities and use of anticoagulation [9,127,133]. Studies indicate that findings on VCE have led to endoscopic or surgical intervention or change in medical management in 37-87% of patients, and in 50-66% of cases there is no rebleeding following VCE-directed interventions [134,135]. The rate of rebleeding in those with negative VCE is low, between 6-11% [136,137] as the negative predictive value (NPV) of VCE is 83-100% [135].…”

“…Studies indicate that findings on VCE have led to endoscopic or surgical intervention or change in medical management in 37-87% of patients, and in 50-66% of cases there is no rebleeding following VCE-directed interventions [134,135]. The rate of rebleeding in those with negative VCE is low, between 6-11% [136,137] as the negative predictive value (NPV) of VCE is 83-100% [135]. If the first VCE is negative, a second VCE may be beneficial and increase diagnostic yield, particularly when occult bleeding changes to overt or there is a decrease in Hgb ≥ 4 g/dL [138][139][140][141].…”

“…The main limitations of VCE use are inability to provide therapeutic intervention, and it may not detect clinically important lesions in the duodenum (because of rapid transit through the duodenal loop) and proximal jejunum [142,143]. Complications associated with VCE include a 2% risk of capsule retention in patients with surgical anastamosis or unknown strictures and rarely, risk of perforation [135,144].…”

Single‐balloon enteroscopy for managing obscure gastrointestinal bleeding: Results from a tertiary medical center in Taiwan

“…Managing OGIB was very challenging until the introduction of capsule endoscopy (CE) in 2000 and double-balloon enteroscopy (DBE) in 2001 [2,3]. However, the use of CE in the diagnosis of OGIB is limited by the image clarity, handling controllability, biopsy, endoscopic treatment, and retention of the capsule in the stenotic intestine [4]. Compared to CE, DBE gives a diagnostic yield of 60-65%, and it overcomes the above limitation [5,6].…”

CT enterography: Mannitol versus VoLumen

“…1 It is also of limited use for localisation of small bowel pathology. 11 When comparing CTE and MRE, they are both generally equivalent for detection of luminal and extraluminal pathology. 12 In general, CTE is more easily accessible and can be performed rapidly.…”