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Capsule Endoscopy: A New Era of Gastrointestinal Endoscopy

Written By

Uday C Ghoshal

Submitted: April 12th, 2012 Reviewed: August 27th, 2012 Published: March 13th, 2013

DOI: 10.5772/52732

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1. Introduction

Background: Since the discovery of fiber-optic endoscopy to examine upper and lower gastrointestinal tract, diagnosis and therapy of gastrointestinal diseases were revolutionized. However, by these methods, of the small bowel, only the proximal duodenum and distal ileum could be examined. Hence, rest of the small bowel, which is more than four meters in length, remained like a black box. With the discovery of capsule endoscopy in 2000,[1] not only the small bowel became visible to the Gastroenterologist, but also it led to discovery of a new technology by which a swallowed capsule could take images of the gastrointestinal track and send these to a computer using radio-frequency transmitter. The value, safety and acceptability of this novel technology are further documented by the fact that within a year of its discovery (2001), it was approved by US Food and Drug Administration.[2] These led to an era of physiological endoscopy the scope of which is now increasing day by day to include colon and esophageal capsule endoscopy, steerable capsule and therapeutic capsule endoscopy.

Aims and Methods: The aims of this chapter are to, (a) review histotical aspects of this important development in medical science, (b) outline the principles of this technology, (c) review existing evidences on clinical impact of capsule endoscopy and its limitation, (d) project the future of capsule endoscopy. Literature was searched for studies on capsule endoscopy using various electronic search engines to review data on capsule endoscopy in relation to various gastrointestinal diseases.

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2. Historical aspects of capsule endoscopy

In science, what is fiction today, may become reality tomorrow. This is amply documented once again by discovery of capsule endoscopy. Capsule endoscopy is a combination of the device that physicist G. Iddan had developed and that devised by Paul Swain.[2], [3] This was an attempt to reproduce the movie fiction filmed by R. Fleischer in 1966, based on a story by I. Asimov.[2] The first reported use of capsule endoscopy in ten human volunteers was published in 2000 by P. Swain in Nature.[1] The first model of capsule endoscopy was made available by Israeli Company Given Imaging by the name of M2A. Within a year of first publication, the capsule endoscopy was approved by US Food and Drug Administration.[4] Subsequently, it has been widely used throughout the World for diagnosis of small bowel diseases.

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3. Small bowel capsule endoscopy: The method

Indications of capsule endoscopy: Indications of capsule endoscopy are summarized in Table 1. Capsule endoscopy is indicated in various small bowel diseases such as obscure gastrointestinal bleeding, celiac disease and other types of malabsorption syndrome, polyposis, Crohn disease etc. Colon capsule and esophageal capsules are used for esophageal and colonic diseases.[5]

Organ evaluatedDiseases or conditions
Small bowel
Obscure gastrointestinal bleeding (overt and occult)
Chronic small bowel diarrhea including celiac disease
Abnormal small bowel imaging
Chronic abdominal pain with reasonable suspicion of organic cause in the small intestine
Evaluation of Crohn disease and its extent
Visualization of surgical anastomosis
Suspected small bowel tumor
Polyposis syndrome
Portal hypertensive enteropathy and small intestinal varices
Esophagus
Barrett esophagus
Esophageal varices
Colon
Colon polyps and colorectal cancer

Table 1.

Indications for capsule endoscopy.

The capsule: Most capsules consist of a lens, 4 light emitting diodes, a color camera, 2 batteries, a radiofrequency transmitter and an antenna (Fig. 1).[4] The camera transmits multiple (usually 2/second) images by radiofrequency through sensor to a recorder. Currently, capsule endoscopy system is marketed by different suppliers, which somewhat differ in technology and in length and weight of capsule, number of cameras and antennas, frame rate per second and duration of battery life. Table 2 summarizes these variables.[5] Before patient swallows the capsule, 8 skin antennas are taped to the anterior abdominal wall (Fig. 1). The capsule, while moving inside gastrointestinal tract, takes images and sends these through radio-frequency transmitters and the sensor array that are fixed at different locations on the anterior abdominal wall (Fig. 1) to the data logger, which is hang on the patient. After study completion, the images are downloaded to a computer and seen as video images with software. The use of the real time viewer may shorten procedures, as the patient can be disconnected once the cecum is visualized.[6] Recently, softwares have been upgraded with additional capabilities to assist the reader, such as ability to localize the capsule, blood indicator, a multi-viewing feature and quick view modality.

Pillcam SB2Pillcam esoPillcam colonMirocamEndocapsuleOMOM
Length in mm262626242627.9
Weight (g)3.43.43.43.43.86
Number of cameras122111
Frame rate per second2184-35322
Image sensorCMOSCMOSCMOSCCDCCDCCD
Battery life (h)8881198
Antennas8389814
Sleeping modeNoNoYesNoNoNo

Table 2.

Comparison of various types of capsules used in capsule endoscopic examinations

Abbreviations used: CMOS: complementary metal oxide semiconductor, CCD: charge-coupled device.


Patient preparation: Initially, capsule endoscopy was done without any preparation. However, dark or opaque fluids, food, biliary secretions, air bubbles and mucus can cause incomplete visualization of small bowel mucosa. Slow gastric emptying and small bowel transit may also lead to incomplete examination of the small bowel in 17 to 25% of patients.[7], [8] Several subsequent studies demonstrated that various methods of bowel preparation using osmotic laxatives such as sodium phosphate, polyethylene glycol, and prokinetics such as erythromycin, metoclopramide, tegaserod, domperidone may improve image quality and completeness of examination of small bowel.[8]-[14] Sodium phosphate and polyethylene glycol, which may also shorten gastric and small intestinal transit time, were found to be superior to erythromycin for this purpose.[8], [15, 16] However, a meta-analysis demonstrated that improved visualization of small bowel mucosa during capsule endoscopy with bowel preparation is independent of any effect on transit time.[17] Oral simethicone, which may reduce intra-luminal air bubble, was associated with better mucosal visibility than placebo.[18, 19] Hence, such preparation to improve small bowel visualization and 12-h fasting before the procedure and ingestion only of clear liquids 2-h hours after capsule ingestion are recommended by most capsule endoscopists. However, the best type of preparation, its dose and time of administration remain to be determined. Concerns have also been raised in relation to use of prokinetics that shorten small bowel transit as this may lead to shorter stay of the capsule at the site of lesions raising possibility of missing the lesions and some workers even suggested that bowel preparation may reduce patients’ acceptability of the procedure.[20, 21] Some studies also suggested that keeping the patient in right lateral position may hasten passage of capsule from stomach to small intestine though there are studies to contradict this.[8], [22] It is important to note that typical gastic passage time of the capsule is one hour and small bowel passage time was four hours.[8]

Figure 1.

Components of capsule endoscopy system including schematic representation of parts of capsule and sensor location guide.

Clinical impact of capsule endoscopy: Several meta-analyses documented that small bowel capsule endoscopy is superior to other methods of small bowel evaluation such as barium small bowel series, CT enteroclysis, double balloon and single balloon endoscopy.[23], [24] Table 3 summarizes yield of capsule endoscopy in patients with obscure gastrointestinal bleeding in some series published during last decade. Capsule endoscopy detected lesions in small bowel in 45-89% patients with obscure gastrointestinal bleeding. Most series showed that lesions are detected more often in patients with obscure overt than occult gastrointestinal bleeding[25], [26] though a few series did contradict this observation.[27] It has also been shown that if capsule endoscopy is performed early after a bleeding episode, it detects lesion more frequently than if it is done late. In some studies, authors showed that second capsule endoscopy may pick-up some of the lesions missed by first study.[28], [29]

Other diseases of small bowel in which capsule endoscopy is indicated are summarized in Table 1. However, capsule endoscopy done in some of these conditions has limitations. For example, in celiac disease,[30] taking biopsy is very important to detect villous atrophy. However, in other conditions such as Crohn disease, small intestinal tumor, polyposis syndrome and portal hypertensive enteropathy and varices, capsule endoscopy is useful.[31]-[36] In endemic areas, hookworm infestation is not uncommonly detected in patients undergoing capsule endoscopy for obsure gastrointestinal bleeding.[27], [37], [38] Fig. 2 (A to F) and 3 (A to F) depict some of these findings on capsule endoscopy. Fig. 4 outlines a practical approach to use various small bowel endoscopic techniques in patients with obscure gastrointestinal bleeding.

StudyLocationYearNumber of patientsIndicationsOverall diagnostic yield
Albert JG et. al.[55]England2008285OGIB76.8%
Almeida N[56]Australia200915Severe overt OGIB73.3%
Apostolopoulos P[57]Germany200651Occult OGIB57%
Apostolopoulos P[58]United States200737Acute mild-to-moderate OGIB91.9%
Ghoshal UC[27]India201186Occult and overt OGIB74.4%
Ben Soussan E[59]France200435OGIB overt (n=17) and occult (n=18)45.7%
Bresci G[60]Japan200564OGIB62.5%
Calabrese C[61]Italy2011346OGIB71%
Carey EJ[26]Unites States2007260OGIB overt (n=126) and occult (n=134)53%
Carlo JT[62]United States2005532532 studies for OGIB49.3%
Chao CC[63]China200535OGIB89%
Chong AK[64]Australia200347OGIB68%
De Leusse A[65]Germany20056464 OGIB (overt 69% and occult 31%)45%
Gupta R[25]India2006154OGIB (overt 74, occult 80)51%
Enns R[66]Canada2004167167 studies, 88 overt, 79 occult)50.8%
Estevez E[67]England2006100OGIB (overt 52, occult 48)68%
Fireman Z[68]England2004160OGIB57.7%
Fireman Z[69]Israel2004293OGIB72%

Table 3.

Summary of some studies on small bowel capsule endoscopy

Abbreviations used: OGIB: obscure gastrointestinal bleeding.


Figure 2.

Representative pictures of capsule endoscopy in patients with small bowel angiodysplasia (A), portal hypertensive jejunopathy (B), varices (C), ileocecal ulceration in a patient with intestinal tuberculosis (D), small bowel stricture in a patient with intestinal tuberculosis (E) and in a patient with Crohn disease (F).

Figure 3.

Representative pictures of capsule endoscopy in patients with intestinal stricture due to tuberculosis with enterolith (A), small bowel tumors (B, C, D), hookworm (E) and active bleeding without an identifiable causative lesion (F).

Figure 4.

An outline of diagnostic algorithm of patients with obscure gastrointestinal bleeding.

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4. Contraindications of capsule endoscopy

Contraindications of capsule endoscopy include suspected intestinal stricture (in which patency capsule may be used to evaluate tightness of the stricture),[39] cardiac pacemaker (recently capsule has been found safe and Capsovision type of capsule is quite safe),[40], [41] gastroparesis and esophageal motility disorders (capsule can be endoscopically delivered in the small bowel).[27] Even if capsule gets retained in stricture, it can be retrieved by single balloon and double balloon enteroscopy. Moreover, precipitation of small bowel obstruction by retained capsule is rare.[27] Pregnancy is also a contraindication to capsule endoscopy.

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5. Complications of capsule endoscopy

Capsule retention is considered as a complication of capsule endoscopy. Capsule retention is defined as having a capsule remain in the digestive tract for a minimum of two weeks. Frequency of capsule retention in various studies varies from 0-13%.[42], [43] In a large series of 900 patients undergoing capsule endoscopy for obscure gastrointestinal bleeding, seven (0.77%) had capsule retention.[43] Interestingly, six of these seven patients had retention in spite a normal barium series. Several subsequent studies showed that normal barium does not prevent possible capsule retention.[27] Hence, a barium small bowel series is not indicated before capsule endoscopy. Moreover, yield of small bowel barium series is low to pick up causes of obscure gastrointestinal bleeding.[23] In an attempt to prevent capsule retention, patency capsule has been developed. This self-dissolving capsule (Fig. 1) of size same as endoscopy capsule, consists of a cellophane-walled cylinder filled with lactose and 10% barium for radio-opaqueness.[42] It is protected by wax plague at one end with a hole that allows influx of small bowel fluid, which dissolves lactose within 5 days. The patency capsule also has a transpoder device inside that helps in its detection using a hand-held scanner placed close to anterior abdominal wall.[42] However, the patency capsule can itself gets impacted in small bowel stricture.[44] Hence, it may not be entirely safe. Moreover, it increases the cost of capsule endoscopy. Hence, it has been suggested that obtaining a good medical history is the best method to avoid capsule retention.[44] Moreover, even if capsule gets retained, which occurs infrequently, precipitation of clinical obstruction is further uncommon. The retained capsule can be retrieved using balloon enteroscopy. Surgical removal, if needed, not only allows retrieving the capsule but also removes the pathology that led to capsule retention.

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6. Esophageal and colon capsule endoscopy

Table 2 summarizes technical differences between esophageal and small bowel capsule endoscopy. Initial studies on esophageal capsule endoscopy did not find it very rewarding for detection of esophageal varices and Barrett esophagus in comparison to conventional esophagogastroduodenoscopy.[45], [46] Subsequently, string-controlled esophageal capsule endoscopy was tried to overcome some of the limitations.[47] However, it has to be noted that esophageal capsule endoscopy is expensive as compared to conventional esophagogastroduodenoscopy, will not have therapeutic potential and is not maneuverable. Hence, esophagogastroduodenoscopy remains the modality of choice for screening for Barrett’s esophagus.[48]

Table 2 summarizes technical specifications of colon capsule endoscopy. Colon capsule endoscopy may score over conventional colonoscopy as it will reduce patients discomfort and need for sedation. However, its efficacy for colon cancer screening, which is likely to be its major indication,[49] remains to be proved in large studies though a few meta-analysis have been reported.[50], [51] If it is effective, it may be useful to improve compliance with colorectal cancer screening. However, this technology is currently only a diagnostic method, any positive finding requires conventional colonoscopy for tissue sampling or polypectomy. There is currently no video capsule device cleared by the US Food and Drug Administration for dedicated colon imaging. This technology requires more research before it can become clinically applicable as standard of care.

Future of capsule endoscopy: Limitations of the current system of capsule endoscopy include inability to steer the capsule, inability to biopsy lesions, and lack of therapeutic potential. Localization and estimation of size of the lesions using capsule endoscopy is often inaccurate. False negative and false positive diagnoses are other limitations. Moreover, in almost 20% of procedures the capsule does not reach the cecum while it is active. However, advances have been made to overcome these limitations. For example, now some of the capsules can be magnetically steered to pass through gastrointestinal tract.[52] Some capsules also provide ability to real time imaging so that the operator can see while the capsule is passing down the GI tract.6 Works are also ongoing to provide therapeutic potential to the imaging capsules.[53] Several methods are being developed to improve image quality by improvement in the software or by chromoendoscopy (FICE).[54]

References

  1. 1. IddanGMeronGGlukhovskyASwainPWireless capsule endoscopy. Nature2000
  2. 2. Vazquez-iglesiasJ. LCapsule endoscopy: a new era in the history of endoscopy. Rev Esp Enferm Dig20049639
  3. 3. IddanG. JSwainC. PHistory and development of capsule endoscopy. Gastrointest Endosc Clin N Am20041419
  4. 4. CareyE. JFleischerD. EInvestigation of the small bowel in gastrointestinal bleeding--enteroscopy and capsule endoscopy. Gastroenterol Clin North Am20053471934
  5. 5. MogliaAMenciassiADarioPCuschieriACapsule endoscopy: progress update and challenges ahead. Nat Rev Gastroenterol Hepatol2009635362
  6. 6. LaiL. HWongG. LLauJ. YSungJ. JLeungW. KInitial experience of real-time capsule endoscopy in monitoring progress of the videocapsule through the upper GI tract. Gastrointest Endosc20076612114
  7. 7. RondonottiEHerreriasJ. MPennazioMCaunedoAMascarenhas-saraivaMDe FranchisRComplications, limitations, and failures of capsule endoscopy: a review of 733 cases. Gastrointest Endosc2005627126quiz 752, 754.
  8. 8. VillaFSignorelliCRondonottiEDe FranchisRPreparations and prokinetics. Gastrointest Endosc Clin N Am20061621120
  9. 9. DaiNGublerCHengstlerPMeyenbergerCBauerfeindPImproved capsule endoscopy after bowel preparation. Gastrointest Endosc2005612831
  10. 10. Ben-soussanESavoyeGAntoniettiMRamirezSDucrottePLereboursEIsaliter PEG preparation useful before capsule endoscopy? J Clin Gastroenterol2005393814
  11. 11. CaddyG. RMoranLChongA. KMillerA. MTaylorA. CDesmondP. VThe effect of erythromycin on video capsule endoscopy intestinal-transit time. Gastrointest Endosc2006632626
  12. 12. EndoHKondoYInamoriMOhyaT. RYanagawaTAsayamaMHisatomiKTerataniTYonedaMNakajimaAMatsuhashiNIngesting 500 ml of polyethylene glycol solution during capsule endoscopy improves the image quality and completion rate to the cecum. Dig Dis Sci20085332015
  13. 13. LapalusM. GBen Soussan E, Saurin JC, Favre O, D’Halluin PN, Coumaros D, Gaudric M, Fumex F, Antonietti M, Gaudin JL, Jacob P, Heresbach D, Pilichos C, Fan R, Mozer M, Heyries L, Dumortier J, Ponchon T. Capsule endoscopy and bowel preparation with oral sodium phosphate: a prospective randomized controlled trial. Gastrointest Endosc20086710916
  14. 14. NivEBongerIBarkayOHalpernZMahajnaEDepsamesRKopelmanYFiremanZEffect of erythromycin on image quality and transit time of capsule endoscopy: a two-center study. World J Gastroenterol20081425615
  15. 15. FiremanZKopelmanYFishLSternbergAScapaEMahainaEEffect of oral purgatives on gastric and small bowel transit time in capsule endoscopy. Isr Med Assoc J200465213
  16. 16. KalantzisCTriantafyllouKPapadopoulosA. AAlexandrakisGRokkasTKalantzisNLadasS. DEffect of three bowel preparations on video-capsule endoscopy gastric and small-bowel transit time and completeness of the examination. Scand J Gastroenterol20074211206
  17. 17. NivYEfficiency of bowel preparation for capsule endoscopy examination: a meta-analysis. World J Gastroenterol20081413137
  18. 18. AlbertJGobelC. MLesskeJLottererENietschHFleigW. ESimethicone for small bowel preparation for capsule endoscopy: a systematic, single-blinded, controlled study. Gastrointest Endosc20045948791
  19. 19. FangY. HChenC. XZhangB. LEffect of small bowel preparation with simethicone on capsule endoscopy. J Zhejiang Univ Sci B2009104651
  20. 20. PostgateATekkisPPattersonNFitzpatrickABassettPFraserCAre bowel purgatives and prokinetics useful for small-bowel capsule endoscopy? A prospective randomized controlled study. Gastrointest Endosc20096911208
  21. 21. BuscagliaJ. MKapoorSClarkeJ. OBucoboJ. CGidayS. AMagnoPYongEMullinG. EEnhanced diagnostic yield with prolonged small bowel transit time during capsule endoscopy. Int J Med Sci200853038
  22. 22. AparicioJ. RMartinezJCasellasJ. ARight lateral position does not affect gastric transit times of video capsule endoscopy: a prospective study. Gastrointest Endosc200969347
  23. 23. TriesterS. LLeightonJ. ALeontiadisG. IFleischerD. EHaraA. KHeighR. IShiffA. DSharmaV. KA meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol2005100240718
  24. 24. LeightonJ. ATriesterS. LSharmaV. KCapsule endoscopy: a meta-analysis for use with obscure gastrointestinal bleeding and Crohn’s disease. Gastrointest Endosc Clin N Am20061622950
  25. 25. GuptaRLakhtakiaSTandanMBanerjeeRRamchandaniMAnuradhaSRamjiCRaoG. VPradeepRReddyD. NCapsule endoscopy in obscure gastrointestinal bleeding--an Indian experience. Indian J Gastroenterol20062518890
  26. 26. CareyE. JLeightonJ. AHeighR. IShiffA. DSharmaV. KPostJ. KFleischerD. EA single-center experience of 260 consecutive patients undergoing capsule endoscopy for obscure gastrointestinal bleeding. Am J Gastroenterol20071028995
  27. 27. GhoshalU. CLakshmiC. PKumarSDasKMisraARaiPMohindraSSaraswatV. AKumarAChoudhuriGCapsule endoscopy for obscure gastrointestinal bleeding in the tropics: report from India. Dig Endosc2011231723
  28. 28. Bar-meirSEliakimRNadlerMBarkayOFiremanZScapaEChowersYBardanESecond capsule endoscopy for patients with severe iron deficiency anemia. Gastrointest Endosc2004607113
  29. 29. ViazisNPapaxoinisKVlachogiannakosJEfthymiouATheodoropoulosIKaramanolisD. GIs there a role for second-look capsule endoscopy in patients with obscure GI bleeding after a nondiagnostic first test? Gastrointest Endosc2009698506
  30. 30. GreenP. HRubinMCapsule endoscopy in celiac disease: diagnosis and management. Gastrointest Endosc Clin N Am20061630716
  31. 31. CiorbaM. APrakashCWireless capsule endoscopy in the diagnosis of small bowel Crohn’s disease. Inflamm Bowel Dis2003
  32. 32. BaileyA. ADebinskiH. SAppleyardM. NRemediosM. LHooperJ. EWalshA. JSelbyW. SDiagnosis and outcome of small bowel tumors found by capsule endoscopy: a three-center Australian experience. Am J Gastroenterol2006101223743
  33. 33. CobrinG. MPittmanR. HLewisB. SIncreased diagnostic yield of small bowel tumors with capsule endoscopy. Cancer2006107227
  34. 34. BurkeC. ASantisiJChurchJLevinthalGThe utility of capsule endoscopy small bowel surveillance in patients with polyposis. Am J Gastroenterol20051001498502
  35. 35. De PalmaG. DRegaMMasoneSPersicoFSicilianoSPatroneFMatantuonoLPersicoGMucosal abnormalities of the small bowel in patients with cirrhosis and portal hypertension: a capsule endoscopy study. Gastrointest Endosc20056252934
  36. 36. GoulasSTriantafyllidouKKaragiannisSNicolaouPGalanisPVafiadisITzivrasMMavrogiannisCCapsule endoscopy in the investigation of patients with portal hypertension and anemia. Can J Gastroenterol20082246974
  37. 37. ChristodoulouD. KSigounasD. EKatsanosK. HDimosGTsianosE. VSmall bowel parasitosis as cause of obscure gastrointestinal bleeding diagnosed by capsule endoscopy. World J Gastrointest Endosc2010236971
  38. 38. DasKSarkarRDasguptaJRaySGhatakSMridhaA. RDhaliG. KChowdhuryAObscure GI bleeding in the tropics: impact of introduction of double-balloon and capsule endoscopies on outcome. Gastrointest Endosc201072292300
  39. 39. SpadaCShahS. KRiccioniM. ESperaGMarcheseMIacopiniFFamiliariPCostamagnaGVideo capsule endoscopy in patients with known or suspected small bowel stricture previously tested with the dissolving patency capsule. J Clin Gastroenterol20074157682
  40. 40. LeightonJ. ASharmaV. KSrivathsanKHeighR. IMcwaneT. LPostJ. KRobinsonS. RBazzellJ. LFleischerD. ESafety of capsule endoscopy in patients with pacemakers. Gastrointest Endosc2004595679
  41. 41. PayerasGPiquerasJMorenoV. JCabreraAMenendezDJimenezREffects of capsule endoscopy on cardiac pacemakers. Endoscopy20053711815
  42. 42. LewisBCapsule endoscopy--transit abnormalities. Gastrointest Endosc Clin N Am2006162218vii.
  43. 43. BarkinJ. SOLoughlinC. Capsule endoscopy contraindications: complications and how to avoid their occurrence. Gastrointest Endosc Clin N Am200414615
  44. 44. DelvauxMBen Soussan E, Laurent V, Lerebours E, Gay G. Clinical evaluation of the use of the M2A patency capsule system before a capsule endoscopy procedure, in patients with known or suspected intestinal stenosis. Endoscopy2005378017
  45. 45. LinO. SSchembreD. BMergenerKSpauldingWLomahNAyubKBrandaburJ. JBredfeldtJDrennanFGluckMJiranekG. CMccormickS. EPattersonDKozarekR. ABlinded comparison of esophageal capsule endoscopy versus conventional endoscopy for a diagnosis of Barrett’s esophagus in patients with chronic gastroesophageal reflux. Gastrointest Endosc20076557783
  46. 46. ChavalitdhamrongDJensenD. MSinghBKovacsT. OHanS. HDurazoFSaabSGornbeinJ. ACapsule endoscopy is not as accurate as esophagogastroduodenoscopy in screening cirrhotic patients for varices. Clin Gastroenterol Hepatol2012102548e1.
  47. 47. RamirezF. CAkinsRShaukatMScreening of Barrett’s esophagus with string-capsule endoscopy: a prospective blinded study of 100 consecutive patients using histology as the criterion standard. Gastrointest Endosc2008682531
  48. 48. BhardwajAHollenbeakC. SPooranNMathewAA meta-analysis of the diagnostic accuracy of esophageal capsule endoscopy for Barrett’s esophagus in patients with gastroesophageal reflux disease. Am J Gastroenterol200910415339
  49. 49. IobagiuSCiobanuLPascuOColon capsule endoscopy: a new method of investigating the large bowel. J Gastrointestin Liver Dis20081734752
  50. 50. RokkasTPapaxoinisKTriantafyllouKLadasS. DA meta-analysis evaluating the accuracy of colon capsule endoscopy in detecting colon polyps. Gastrointest Endosc2010717928
  51. 51. SpadaCHassanCMarmoRPetruzzielloLRiccioniM. EZulloACesaroPPilzJCostamagnaGMeta-analysis shows colon capsule endoscopy is effective in detecting colorectal polyps. Clin Gastroenterol Hepatol2010851622
  52. 52. CarpiFMagnetic capsule endoscopy: the future is around the corner. Expert Rev Med Devices201071614
  53. 53. Van GossumAIbrahimMVideo capsule endoscopy: what is the future? Gastroenterol Clin North Am20103980726
  54. 54. Crespo-perezLVazquez-sequeirosEVirtual chromoendoscopy as an adjuvant to capsule endoscopy: a step ahead? Rev Esp Enferm Dig201210422730
  55. 55. AlbertJ. GSchulbeRHahnLHeinigDSchoppmeyerKPorstHLorenzRPlauthMDollingerM. MMossnerJCacaKFleigW. EImpact of capsule endoscopy on outcome in mid-intestinal bleeding: a multicentre cohort study in 285 patients. Eur J Gastroenterol Hepatol2008209717
  56. 56. AlmeidaNFigueiredoPLopesSFreirePLeriasCGouveiaHLeitaoM. CUrgent capsule endoscopy is useful in severe obscure-overt gastrointestinal bleeding. Dig Endosc2009218792
  57. 57. ApostolopoulosPLiatsosCGralnekI. MGiannakoulopoulouEAlexandrakisGKalantzisCGabrielPKalantzisNThe role of wireless capsule endoscopy in investigating unexplained iron deficiency anemia after negative endoscopic evaluation of the upper and lower gastrointestinal tract. Endoscopy200638112732
  58. 58. ApostolopoulosPLiatsosCGralnekI. MKalantzisCGiannakoulopoulouEAlexandrakisGTsibourisPKalafatisEKalantzisNEvaluation of capsule endoscopy in active, mild-to-moderate, overt, obscure GI bleeding. Gastrointest Endosc200766117481
  59. 59. Ben Soussan EAntonietti M, Herve S, Savoye G, Ramirez S, Lecleire S, Ducrotte P, Lerebours E. Diagnostic yield and therapeutic implications of capsule endoscopy in obscure gastrointestinal bleeding. Gastroenterol Clin Biol200428106873
  60. 60. BresciGParisiGBertoniMTuminoECapriaAThe role of video capsule endoscopy for evaluating obscure gastrointestinal bleeding: usefulness of early use. J Gastroenterol2005402569
  61. 61. CalabreseCLiguoriGGionchettiPRizzelloFLauretiSSimoneM. PPoggioliGCampieriMObscure gastrointestinal bleeding: single centre experience of capsule endoscopy. Intern Emerg Med2011
  62. 62. CarloJ. TDemarcoDSmithB. ALivingstonSWiserKKuhnJ. ALamontJ. PThe utility of capsule endoscopy and its role for diagnosing pathology in the gastrointestinal tract. Am J Surg200519088690
  63. 63. ChaoC. CNg Jao YT, Mo LR. Capsule endoscopy for gastrointestinal bleeding with an obscure etiology. J Formos Med Assoc200510465965
  64. 64. ChongA. KTaylorA. CMillerA. MDesmondP. VInitial experience with capsule endoscopy at a major referral hospital. Med J Aust200317853740
  65. 65. De LeusseALandiBEderyJBurtinPLecomteTSeksikPBlochFJianRCellierCVideo capsule endoscopy for investigation of obscure gastrointestinal bleeding: feasibility, results, and interobserver agreement. Endoscopy20053761721
  66. 66. EnnsRGoKChangHPlutaKCapsule endoscopy: a single-centre experience with the first 226 capsules. Can J Gastroenterol2004185558
  67. 67. EstevezEGonzalez-condeBVazquez-iglesiasJ. Lde Los Angeles Vazquez-Millan M, Pertega S, Alonso PA, Clofent J, Santos E, Ulla JL, Sanchez E. Diagnostic yield and clinical outcomes after capsule endoscopy in 100 consecutive patients with obscure gastrointestinal bleeding. Eur J Gastroenterol Hepatol2006188818
  68. 68. FiremanZEliakimRAdlerSScapaECapsule endoscopy in real life: a four-centre experience of 160 consecutive patients in Israel. Eur J Gastroenterol Hepatol20041692731
  69. 69. FiremanZFriedmanSDiagnostic yield of capsule endoscopy in obscure gastrointestinal bleeding. Digestion2004702016

Written By

Uday C Ghoshal

Submitted: April 12th, 2012 Reviewed: August 27th, 2012 Published: March 13th, 2013