Wireless Capsule Endoscopy of the Small Intestine

A Review With Future Directions

Helmut Neumann; Lucía C. Fry; Andreas Nägel; Markus F. Neurath

Disclosures

Curr Opin Gastroenterol. 2014;30(5):463-471. 

In This Article

Abstract and Introduction

Abstract

Purpose of review Here, we review the clinical applications of small bowel capsule endoscopy. Moreover, we provide an outlook on the exceptional future developments of small bowel capsule endoscopy. We discuss clinical algorithms for diagnosis of small bowel diseases. Multiple studies have shown the potential of capsule endoscopy for identification of the bleeding source located in the small bowel and the increased diagnostic yield over radiographic studies. Capsule endoscopy could detect villous atrophy and severe complications in patients with nonresponsive celiac disease. In addition, small bowel capsule endoscopy was proven as a valid tool to diagnose polyps and tumors and Crohn's disease.

Summary Major current clinical indications of capsule endoscopy in the small bowel include evaluation of obscure gastrointestinal bleeding, diagnosis and surveillance of small bowel polyps and tumors, celiac disease and Crohn's disease. Recent developments have also passed the way for small bowel capsule endoscopy to become a therapeutic instrument.

Introduction

The small bowel has an average length of 7 m with a diameter of 2.5–3 cm and is mainly responsible for digestion and absorption of food. Although the small bowel is the largest portion of the luminal gastrointestinal tract, thorough examination of the small bowel was for a long time restricted to radiological imaging techniques and endoscopic approaches by using long endoscopes.[1,2]

Wireless, small bowel capsule endoscopy was invented by Gavriel Iddan, an electro-optical engineer who previously worked at the Israeli military manufacturer Rafael Israel Armament Development Authority, developing guided-missile technology. During a sabbatical year in Boston, Iddan was challenged by a neighbor, an Israeli gastroenterologist who suffered from chronic abdominal pain of unknown cause, to invent an endoscope that could make its way through the entire gastrointestinal tract. After 20 years of development, Iddan was issued patent for capsule endoscopy in 1997. Within recent years, the advent of capsule endoscopy has revolutionized our way of how to examine the small bowel in a gentle and elegant fashion. Moreover, capsule endoscopy provided new insights on the appearance and clinical relevance of small bowel diseases in a noninvasive and painless fashion. It is of capricious fate that capsule endoscopy, despite its beneficial use in multiple indications, was shown to be only of limited effectiveness for evaluation of chronic abdominal pain.[3–5] General indications of wireless capsule endoscopy according to different locations are as follows:

  1. Esophagus

    1. Gastroesophageal reflux disease

    2. Barrett

    3. Esophageal varices

  2. Small bowel

    1. Obscure gastrointestinal bleeding

    2. Intestinal tumors

    3. Crohn's disease

    4. Celiac disease

    5. Malabsorption

  3. Colon

    1. Polyps

    2. Cancer

  4. General

    1. Diarrhea

    2. Abdominal pain

Here, we review the clinical applications of small bowel capsule endoscopy, focusing on gastrointestinal bleeding, celiac disease, intestinal tumors and small bowel Crohn's disease. Moreover, we provide an outlook on the future developments of small bowel capsule endoscopy. We discuss clinical algorithms for diagnosis of small bowel diseases. The review is underlined by high-quality endoscopic images highlighting findings of small bowel capsule endoscopy.

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