Capsule Endoscopy: The Answer to a Challenge

Abstract

Before the introduction of capsule endoscopy into clinical practice, the small bowel was mainly studied by means of indirect, invasive, and insensitive tools. Capsule endoscopy has provided a safe, well-tolerated and patient-friendly method to painlessly inspect the entire small bowel. The advent of this new device has encouraged gastroenterologists to devote increased attention to small-bowel diseases. In fact, more than 220 studies, accounting for about 22,000 procedures, have been published so far, exploring the potential role of capsule endoscopy in different clinical conditions. Based on the available evidence, practical guidelines have been released and continuously updated. While international scientific societies recommend capsule endoscopy as a third examination after negative bidirectional endoscopy in patients with obscure gastrointestinal bleeding, in other clinical conditions, such as suspected Crohn’s disease, celiac disease, or small-bowel tumors, they advocate an important role for this examination. However, while in the last 10 years, the capsule has undergone substantial improvements, concerns regarding its technical, practical (patient preparation with laxatives and/or prokinetics before the procedure), and clinical (the low specificity for mucosal lesions, the risk of capsule retention) aspects remain. Capsule endoscopy has had a pivotal role in the development of “wired” enteroscopes for the study of the small bowel with additional therapeutic capabilities. The most recent enteroscopes (device-assisted enteroscopes) seek to overcome some of the limitations of capsule endoscopy, enabling therapeutic procedures to be performed inside the small bowel.