Capsule Endoscopy

Abstract

IntroductionThis year's Digestive Disease Week saw the presentation of more than 80 studies focusing on capsule endoscopy (CE); this review discusses in detail the 20 most significant of these. Alongside various reports concerning technical aspects of the procedure, possible new applications have been studied, including in celiac disease. Obscure bleeding is now a consolidated indication to CE; however, prospective data on the impact of CE on clinical out− comes are still scarce. Opinions diverge on the effective role of CE in Crohn's disease, and further research is needed to define this role. Research is also underway to develop capsules with propulsive and therapeutic capabilities. The strong interest in small−bowel endoscopy is also shown by the numerous studies concerning double−balloon enteroscopy, a complementary pro− cedure to CE ( Figure 1). Technical Factors, Assessment, and Other AspectsThe time spent by the physician in evaluating the images appears to be the most costly part of CE. The increasing number of pre− scriptions of CE makes it imperative to evaluate whether other health professionals may be able to replace the doctor in the ini− tial reading of the film. In one study, 20 consecutive CE exams were reviewed by one CE−experienced gastroenterologist and by one endoscopy nurse and one resident previously trained in CE [1]. The gastroenterologist's sensitivity for "overall lesions" was lower and the specificity higher compared with both nurse and resident (with sensitivities of 79 %, 86 %, and 80 %, respectively, and specificities of 99 %, 43 %, and 57 %). Interobserver agreement for "overall lesions" was discrete to moderate (kappa 0.62, 0.30, and 0.33 for gastroenterologist, nurse, and resident, respectively) and excellent for "significant lesions" (kappa = 1 for all readers). In another prospective study, 50 CE videos were preread by a specially−trained gastroenterology nurse, who thumbnailed ab− normalities detected for interpretation by the gastroenterologist [2]. There was complete agreement between the nurse and the gastroenterologist for all 12 cases interpreted as normal by the gastroenterologist. In the remaining 38 cases, the nurse created 130 thumbnail selections and the physician 99. Complete inter− observer agreement was achieved for 93 of the 96 lesions cate− gorized as "significant" by the physician (96.9 %). This approach was reported to save $ 324 per CE examination. BleedingIt is still not entirely clear whether CE or push enteroscopy (PE) is the most efficient strategy in terms of diagnosis and therapeutic impact in patients with obscure gastrointestinal bleeding (OGIB). An interesting prospective randomized study [3] compared a strategy based on one or the other examination in 78 patients. The alternative examination was only performed when no lesion was evidenced in the first one, or in case of clinical necessity dur− ing the 1−year follow−up period. The percentage of patients hav− ing to undergo the alternative examination was 74 % for CE and 77 % for PE. If the 100 % negat...

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“…15, 19 Obscure GI bleeding of presumed small-bowel origin is the principal indication for CE. 20, 21 …”

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