Capsule endoscopy - a non-invasive modality to investigate the GI tract: out with the old and in with the new?

ABSTRACT

Introduction

Capsule endoscopy has had significant development since it was introduced into the field of medicine in 2000. It is non-invasive, well tolerated, does not require sedation and is a first-line small bowel investigative modality. As it transits through the entire gastrointestinal (GI) tract, it has the potential to provide a pan-enteric examination.

Areas covered

In this review we will discuss the new diagnostic modalities along with traditional methods which have been used for examination of the gastro intestinal (GI) tract. The main focus of this review will be on the use of capsule endoscopy for pan-enteric examination.

Expert opinion

Capsule endoscopy is an accepted first-line investigation for the small bowel. Diagnostic sensitivity of the colon capsule is comparable to colonoscopy in controlled trials and is being evaluated in high-risk patients in routine clinical practice in national programs. Preliminary data suggest that a magnetic-controlled examination of the upper GI tract could be developed to enable a complete upper GI examination.

KEYWORDS:

• Capsule endoscopy
• magnetic capsule
• endoscopy
• imaging
• colon capsule
• small bowel

Article highlights

• Endoscopy is an aerosol generating procedure with an increasing demand.

• Capsule endoscopy of the upper GI tract is well tolerated and could help reduce pressures on endoscopy services.

• Although MDCT gastrography has high sensitivity in detecting gastric cancer, it exposes patients to higher levels of radiation and is time consuming.

• SBCE is a safe and reliable method for examination of the small bowel.

• DBE is the most commonly used technique for small bowel sampling and therapy.

• With the expansion of the bowel cancer screening program the demand for colonoscopy is rising.

• ESGE recommends a colon capsule as an alternative for those patients who cannot have a colonoscopy.

• Pan-enteric capsule endoscopy is a safe and reliable method to assess disease activity in patients with non stricturing Crohns disease.

• A patency capsule should be used prior in patients with suspected stricturing Crohn’s to minimize the risk of capsule retention.

Abbreviations

GI (gastro intestinal), MACE (magnetically controlled capsule endoscopy), SBCE (small bowel capsule endoscopy), DBE (double balloon enteroscopy), NHS (national health services), FIT (fecal immunochemical testing)

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

R. Sidhu designed the review. R. Sidhu, M. McAlindon and P Oka wrote the initial draft and all authors approved the final draft of the manuscript.

Additional information

Funding

This paper was not funded.