Small-Intestinal Endoscopy

Abstract

A small imaging capsule without cables, wires, or external connections has been developed for exploration of the small bowel. This swallowable device is propelled by peristalsis through the intestinal tract, and transmits data to a nearby receiver that captures video images on a regular basis. This technology will soon be available throughout the world, and it promises to revolutionize deep endoscopy of the small bowel. Sonde enteroscopy will be laid to rest forever. There continues to be considerable interest in the use of push enteroscopy in the investigation of obscure gastrointestinal bleeding. Physicians are beginning to rely more on intraoperative enteroscopy, because of its high degree of accuracy and its ability to provide visualization of the entire small bowel in selected patients in whom the bleeding source cannot be diagnosed, but who require blood transfusions.

Video Capsule Endoscopy for Investigation of Obscure Gastrointestinal Bleeding: Feasibility, Results, and Interobserver Agreement

“…In 5 ± 40 % of patients with gastrointestinal bleeding, the under− lying cause remains undetected after upper gastrointestinal en− doscopy and colonoscopy [1,2]. In most of these patients the source of bleeding is in the small intestine.…”

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IntroductionIn 5 ± 40 % of patients with gastrointestinal bleeding, the under− lying cause remains undetected after upper gastrointestinal en− doscopy and colonoscopy [1,2]. In most of these patients the source of bleeding is in the small intestine.

Radiological methods of screening the small intestine include small−bowel barium follow−through and abdominal computed tomography with enteroclysis, but the diagnostic value of these methods remains limited in gastrointestinal bleeding of obscure origin.

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Reproducibility of Wireless Capsule Endoscopy in the Investigation of Chronic Obscure Gastrointestinal Bleeding

“…Evaluation of COGB is still one of the challenges in gastroenterology. It is estimated that in 5% to 10% of patients with COGB, the bleeding source cannot be identified by standard endoscopic techniques (ie, upper endoscopy and colonoscopy) (1,2,12). For the diagnosis of COGB, it is suggested that a second upper endoscopy or "second opinion endoscopy" be performed, due to the high frequency of lesions that are overlooked at the initial endoscopy (1).…”

“…in the investigation of chronic obscure gastrointestinal bleeding C hronic obscure gastrointestinal bleeding (COGB) is defined as bleeding of unknown origin that persists or recurs (ie, recurrent or persistent iron deficiency anemia, fecal occult blood testing positivity or visible bleeding) after a negative initial or primary endoscopic evaluation (colonoscopy and upper endoscopy) (1,2). The evaluation of COGB involves a series of increasingly interventional investigations such as repeat esophagogastroduodenoscopy and colonoscopy, push enteroscopy (PE) and small intestinal (SI) x-ray study (eg, enteroclysis), nuclear isotope bleeding scan, Meckel scan, angiography and intraoperative enteroscopy.…”

Therapeutic management options for patients with obscure gastrointestinal bleeding

“…Sonde enteroscopy allows detection of bleeding lesions which are located beyond the reach of push enteroscopy [Berner et al 1994]. However, because the procedure is very prolonged in duration and cannot perform any more advanced therapies, this modality is no longer utilized in clinical practice [Waye, 2001].…”