Earlier use of capsule endoscopy in clinical practice: don’t hold back the scouts

Abstract

We read with interest the recent study by Marya et al, 1 a randomized controlled trial comparing early video capsule endoscopy with conventional investigative pathways in patients with nonhematemesis GI bleeding. The authors found that patients receiving early capsule endoscopy were more likely to have the bleeding source localized, particularly to the colon, and were more likely to have vascular causes of bleeding identified. These results are corroborated by another recent study from our tertiary care center in Scotland. 2 In a retrospective review of inpatients undergoing capsule endoscopy for acute/severe iron-deficiency anemia and melena, we compared patients undergoing capsule endoscopy soon after the negative results of initial upper GI endoscopy with those who underwent capsule endoscopy after negative results of bidirectional endoscopies. Earlier capsule endoscopy proved effective in selecting patients for further colonoscopies by excluding the small bowel as the bleeding source or directly visualizing bleeding in the colon. Crucially, the patients who did not proceed to colonoscopy after capsule endoscopy because a cause was found did not experience adverse outcomes when followed up. Furthermore, both studies provide sufficient evidence that capsule endoscopy can often be performed sooner in the acute to semiacute setting because of its noninvasive nature and ease of administration when compared with conventional endoscopy. This is a significant advantage because earlier investigation increases the likelihood of identifying and therefore treating bleeding sources 3 and of reducing hospitalization time. Interestingly, both prospective and retrospective studies have yielded similar results in patients with general nonhematemesis GI bleeding and also in our more selected group with a higher clinical suspicion of small-bowel bleeding specifically. This has clinical and financial implications, suggesting that with the earlier use of capsule endoscopy in patients with GI bleeding, a definitive diagnosis can be reached more often, routes of investigation optimized, and the number of investigations and length of hospital stays reduced.

5G‐based remote magnetically controlled capsule endoscopy for examination of the stomach and small bowel

“…8 Therefore, the use of telemedicine has mainly played a role in remote consultation, training and triaging of endoscopic procedures in endoscopy area. [9][10][11] Magnetically controlled capsule endoscopy (MCE), with equally favorable diagnostic accuracy as conventional gastroscopy, has become an efficient and comfortable diagnostic modality for GI diseases. 12,13 The endoscopist could control the movement of the capsule inside human body precisely through the manipulation of the magnetic robot arm.…”

“…In addition, network delay and instability has invariably been an obstacle to real‐time remote operation 8 . Therefore, the use of telemedicine has mainly played a role in remote consultation, training and triaging of endoscopic procedures in endoscopy area 9–11 …”

“… 8 Therefore, the use of telemedicine has mainly played a role in remote consultation, training and triaging of endoscopic procedures in endoscopy area. 9 , 10 , 11 …”

Panenteric capsule endoscopy: a new soldier at the forefront of lower gastrointestinal bleeding workup and…beyond!

“…The approach certainly calls for further evaluation and protocol refinement, regarding the position and the timing of PCE in a (not-so-well-defined) standard of care for LGIB. PCE should be seen as a triage tool with potential advantages not limited to improving diagnostic yield or guiding therapeutic interventions but also reducing the length of inpatient stay and associated costs [10,11]. PCE fits well in the emergency setting as is noninvasive and easy to administer.…”