European Radiology

, Volume 17, Issue 12, pp 3103–3111 | Cite as

Capsule enteroscopy and radiology of the small intestine

  • Frans-Thomas ForkEmail author
  • Lars Aabakken


In a very few years, the video capsule for small bowel enteroscopy has gained widespread clinical acceptance. It is readily ingested, disposable, and allows for a complete, low-invasive endoscopic examination of the entire mucosa of the small bowel. It is a patient-friendly method and a first-line procedure in the difficult evaluation of obscure gastrointestinal bleeding. It has the highest proven figure of diagnostic sensitivity for detecting lesions of the mucosa, irrespective of aetiology. The limitations of capsule endoscopy include difficulty in localising mucosal lesions anatomically and its restricted use in patients with dysphagia, strictures or motor dysfunction. Strictures, transmural and extra-mural lesions in patients with small bowel Crohn’s disease are evaluated by MRI- enterography and CT-enterography.


Enteroclysis Capsule enteroscopy Small bowel Radiology Endoscopy 


  1. 1.
    Maglinte DDT, Lappas JC, Kelvin FM, Rex D, Chernish SM (1987) Small bowel radiography: how, when, and why? Radiology 163:297–305PubMedGoogle Scholar
  2. 2.
    Ekberg O, Ekholm S (1980) Radiography in primary tumors of the small bowel. Acta Radiol Diagn 21:79–84Google Scholar
  3. 3.
    Maglinte DDT (2006) Capsule imaging and the role of radiology in the investigation of diseases of the small bowel. Eur Radiol 16:967–971PubMedCrossRefGoogle Scholar
  4. 4.
    Lewis BS (1999) The history of enteroscopy. Gastrointest Endosc Clin N Am 9:1–11PubMedGoogle Scholar
  5. 5.
    Iddan GJ, Swain CP (2004) History and development of capsule endoscopy. Gastrointest Endosc Clin N Am 14:1–9PubMedCrossRefGoogle Scholar
  6. 6.
    Barkin J, Friedman S (2002) Wireless capsule endoscopy requiring surgical intervention: the world’s experience (abstr). Am J Gastroenterol 97:S298CrossRefGoogle Scholar
  7. 7.
    Lewis BS, Eisen GM, Friedman S (2005) A pooled analysis to evaluate results of capsule endoscopy trials. Endoscopy 37:960–965PubMedCrossRefGoogle Scholar
  8. 8.
    Marma R, Rotondano G, Piscopo R, Bianco MA, Cipolletta L (2005) Meta-analysis: capsule enteroscopy vs. conventional modalities in diagnosis of small bowel diseases. Aliment Pharmacol Ther 22: 595–604CrossRefGoogle Scholar
  9. 9.
    Triester SL, Leighton JA, Leontiadis GI, Fleischer DE, Hara AK, Heigh RI, Shiff AD, Sharma VK (2005) A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 100:2407–2418PubMedCrossRefGoogle Scholar
  10. 10.
    Pennazio M, Eisen G, Goldfarb N (2005) ICCE consensus for obscure gastrointestinal bleeding. Endoscopy 37:1046–1050PubMedCrossRefGoogle Scholar
  11. 11.
    Apostolopoulos P, Liatsos C, Gralnek IM, Giannakoulopoulou E, Alexandrakis G, Kalantzis C, Gabriel P, Kalantzis N (2006) The role of wireless capsule endoscopy in investigating unexplained iron deficiency anemia after negative endoscopic evaluation of the upper and lower gastrointestinal tract. Endoscopy 38:1127–1132PubMedCrossRefGoogle Scholar
  12. 12.
    Gurudu SR, Fleisher DE (2006) From small-bowel bleeding to anemia: a wider range of indications for the capsule endoscope? Editorial. Endoscopy 38:1144–1145Google Scholar
  13. 13.
    Trieste SL, Leighton JA, Leontiadis GJ, Gurudu SR, Fleischer DE, Hara AK, Heigh RJ, Shiff AD, Sharma VR (2006) A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn’s disease. Am J Gastroenterol 101:954–964CrossRefGoogle Scholar
  14. 14.
    Mosse CA, Swain CP (1999) Technical advances and experimental devices for enteroscopy. Gastrointest Endosc Clin N Am 9:145–161PubMedGoogle Scholar
  15. 15.
    Iddan G, Meron G, Glukhovsky A, Swain P (2000) Wireless capsule endoscopy. Brief communications. Nature 405:417PubMedCrossRefGoogle Scholar
  16. 16.
    Eliakim R, Fireman Z, Gralnek IM, Yassin K, Waterman M, Kopelman Y, Lachter J, Koslowsky B, Adler SN (2006) Evaluation of the PillCam Colon capsule in the detection of colonic pathology: results of the first multicenter, prospective, comparative study. Endoscopy 38:963–970PubMedCrossRefGoogle Scholar
  17. 17.
    Cave DR (2004) Reading wireless video capsule endoscopy. Gastrointest Endosc Clin N Am 14:17–24PubMedCrossRefGoogle Scholar
  18. 18.
    Eliakim RA (2006) Video capsule endoscopy of the small bowel (PillCam SB). Curr Opin Gastroenterol 22:124–127PubMedCrossRefGoogle Scholar
  19. 19.
    De Leusse A, Landi B, Edery J, Burtin P, Lecomte T, Seksik P, Bloch F, Jian R, Cellier C (2005) Video capsule endoscopy for investigation of obscure gastrointestinal bleeding: feasibility, results, and interobserver agreement. Endoscopy 37:617–621PubMedCrossRefGoogle Scholar
  20. 20.
    Niv Y, Niv G (2004) Capsule endoscopy: role of bowel preparation in successful visualization. Scand J Gastroenterol 39:1005–1009PubMedCrossRefGoogle Scholar
  21. 21.
    Dai N, Gubler C, Hengstler P, Meyenberger C, Bauerfeind P (2005) Improved capsule endoscopy after bowel preparation. Gastrointest Endosc 61:28–31PubMedCrossRefGoogle Scholar
  22. 22.
    de Franchis R, Avgerinos A, Barkin J, Cave D, Filoche B (2005) ICCE consensus on bowel preparation and prokinetics. Endoscopy 37:1040–1045PubMedCrossRefGoogle Scholar
  23. 23.
    Goldstein JL, Eisen GM, Lewis B, Gralnek IM, Zlotnick S, Fort JG (2005) Video capsule endoscopy to prospectively assess small bowel injury with celecoxib, naproxen plus omeprazole, and placebo. Clin Gastroenterol Hepatol 3:133–141PubMedCrossRefGoogle Scholar
  24. 24.
    Sturniolo GC, Di Leo V, Vettorato MG, D’Inca R (2005) Clinical relevance of small-bowel findings detected by wireless capsule endoscopy. Scand J Gastroenterol 40:725–733PubMedCrossRefGoogle Scholar
  25. 25.
    Lewis BS, Swain P (2002) Capsule endoscopy in the evaluation of patients with suspected small bowel bleeding: the result of a pilot study. Gastrointest Endoscop 56:452–456CrossRefGoogle Scholar
  26. 26.
    Pennazio M, Santucci R, Rondonotti E, Abbiati C, Beccari G, Rossini FP, De Franchis R (2004) Outcome of patients with obscure gastrointestinal bleeding after endoscopy: report of 100 consecutive cases. Gastroenterology 126:643–653PubMedCrossRefGoogle Scholar
  27. 27.
    Tang SJ, Haber GB (2004) Capsule endoscopy in obscure gastrointestinal bleeding. Gastroint Endosc 14:87–100CrossRefGoogle Scholar
  28. 28.
    Pennazio M, Eisen G, Goldfarb N (2005) ICCE consensus for obscure gastrointestinal bleeding. Endoscopy 37:1046–1050PubMedCrossRefGoogle Scholar
  29. 29.
    Triester SL, Leighton JA, Leontiadis GI, Fleischer DE, Hara AK, Heigh RI, Shiff AD, Sharma VK (2005) A Meta-Analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 100:2407–2418PubMedCrossRefGoogle Scholar
  30. 30.
    Malik A, Lukaszewski K, Caroline D, Parkman H, DeSipio J, Banson F, Bazir K, Reddy L, Srinivasan R, Fisher R, Miller L (2005) A retrospective review of enteroclysis in patients with obscure gastrointestinal bleeding and chronic abdominal pain of undetermined etiology. Dig Dis Sci 50:649–655PubMedCrossRefGoogle Scholar
  31. 31.
    Adler SN, Jacob H (2005) Occult inflammatory small-bowel disease: not so occult anymore. Scand J Gastroenterol 40:360–364PubMedCrossRefGoogle Scholar
  32. 32.
    Eliakim R, Adler SN (2004) Capsule video endoscopy in Crohn’s disease-the European experience. Gastrointest Endosc Clin N Am 14:129–137PubMedCrossRefGoogle Scholar
  33. 33.
    Ge ZZ, Hu YB, Xiao SD (2004) Capsule endoscopy in diagnosis of small bowel Crohn’s disease. World J Gastroenterol 10:1349–1352PubMedGoogle Scholar
  34. 34.
    Kornbluth A, Colombel JF, Leighton JA, Loftys E (2005) ICCE consensus for inflammatory bowel disease. Endoscopy 37:1051–1054PubMedCrossRefGoogle Scholar
  35. 35.
    Eliakim R, Fischer D, Suissa A, Yassin K, Katz D, Guttman N, Migdal M (2003) Wireless capsule video endoscopy is a superior diagnostic tool in comparison to barium follow-through and computerized tomography in patients with suspected Crohn’s disease. Eur J Gastroenterol Hepatol 15:363–367PubMedCrossRefGoogle Scholar
  36. 36.
    Voderholzer WA, Beinhoelzl J, Rogalla P, Murrer S, Schachschal G, Lochs H, Ortner MA (2005) Small bowel involvement in Crohn’s disease: a prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis. Gut 54:369–373PubMedCrossRefGoogle Scholar
  37. 37.
    Fireman Z, Eliakim R, Adler S, Scapa E (2004) Capsule endoscopy in real life: a four-centre experience of 160 consecutive patients in Israel. Eur J Gastroenterol Hepatol 16:927–931PubMedCrossRefGoogle Scholar
  38. 38.
    Lomas DJ (2003) Technical developments in bowel MRI. (Review) Eur Radiol 13:1058–1071PubMedGoogle Scholar
  39. 39.
    Laghi A, Paolantonio P, Passariello R (2005) Small bowel (Review). Magn Reson Imaging Clin N Am 13:331–348PubMedCrossRefGoogle Scholar
  40. 40.
    Gourtsoyiannis NC, Papanikolaou N (2005) Magnetic resonance enteroclysis. (Review) Semin Ultrasound CT MR 26:237–246PubMedCrossRefGoogle Scholar
  41. 41.
    Wiarda BM, Kuipers EJ, Houdijk LP, Tuynman HA (2005) MR enteroclysis: imaging technique of choice in diagnosis of small bowel disease. Dig Dis Sci 50:1036–1040PubMedCrossRefGoogle Scholar
  42. 42.
    Maglinte DD, Lappas JC, Heitkamp DE, Bender GN, Kelvin FM (2003) Technical refinements in enteroclysis. Radiol Clin North Am 41:213–222PubMedCrossRefGoogle Scholar
  43. 43.
    Romano S, De Lutio E, Rollandi GA, Romano L, Grassi R, Maglinte DD (2005) Multidetector computed tomography enteroclysis (MDCT-E) with neutral enteral and IV contrast enhancement in tumor detection. Eur Radiol 15:1178–1183PubMedCrossRefGoogle Scholar
  44. 44.
    Horton KM, Fishman EK (2003) The current status of multidetector row CT and three-dimensional imaging of the small bowel. Radiol Clin North Am 41:199–212PubMedCrossRefGoogle Scholar
  45. 45.
    Albert JG, Martiny F, Krummenerl A, Stock K, Lesske J, Gobel CM, Lotterer E, Nietsch HH, Behrmann C, Fleig WE (2005) Diagnosis of small bowel Crohn’s disease: a prospective comparison of capsule endoscopy with magnetic resonance imaging and fluoroscopic enteroclysis. Gut 54:1721–1727PubMedCrossRefGoogle Scholar
  46. 46.
    Schreyer AG, Seitz J, Feuerbach S, Rogler G, Herfarth H (2004) Modern imaging using computer tomography and magnetic resonance imaging for inflammatory bowel disease (IBD) Inflamm Bowel Dis 10:45–54PubMedCrossRefGoogle Scholar
  47. 47.
    Eliakim R, Suissa A, Yassin K, Katz D, Fischer D (2004) Wireless capsule video endoscopy compared to barium follow-through and computerised tomography in patients with suspected Crohn’s disease-final report. Dig Liver Dis 36:519–522PubMedCrossRefGoogle Scholar
  48. 48.
    Guilhon de Araujo Sant’Anna AM, Dubois J, Miron MC, Seidman EG (2005) Wireless capsule endoscopy for obscure small-bowel disorders: final results of the first pediatric controlled trial. Clin Gastroenterol Hepatol 3:264–270PubMedCrossRefGoogle Scholar
  49. 49.
    Arguelles-Arias F, Caunedo A, Romero J, Sanchez A, Rodriguez-Tellez M, Pellicer FJ, Arguelles-Martin F, Herrerias JM (2004) The value of capsule endoscopy in pediatric patients with a suspicion of Crohn’s disease. Endoscopy 36:869–873PubMedCrossRefGoogle Scholar
  50. 50.
    Goldfarb NI, Pizzi LT, Fuhr JP Jr, Salvador C, Sikirica V, Kornbluth A, Lewis B (2004) Diagnosing Crohn’s disease: an economic analysis comparing wireless capsule endoscopy with traditional diagnostic procedures. Dis Manag 7:292–304PubMedCrossRefGoogle Scholar
  51. 51.
    Schulmann K, Hollerbach S, Kraus K, Willert J, Vogel T, Moslein G, Pox C, Reiser M, Reinacher-Schick A, Schmiegel W (2005) Feasibility and diagnostic utility of video capsule endoscopy for the detection of small bowel polyps in patients with hereditary polyposis sybndromes. Am J Gastroenterol 100:27–37PubMedCrossRefGoogle Scholar
  52. 52.
    Soares J, Lopes L, Vilas Boas G, Pinho C (2004) Wireless capsule endoscopy for the evaluation of phenotypic expression of small bowel polyps in patiens with Peutz-Jeghers syndrome and in symptomatic first-degree relatives. Endoscopy 36:1060–1066PubMedCrossRefGoogle Scholar
  53. 53.
    Graham DY, Opekun AR, Willingham FF, Qureshi WA (2005) Visible small bowel intestinal mucosal injury in chronic NSAID users. Clin Gastroenterol Hepatol 3:55–59PubMedCrossRefGoogle Scholar
  54. 54.
    de Franchis R, Rondonotti E, da Silva Araujo Lopes LM (2004) Small bowel malignancy. Gastrointest Endosc Clin N Am 14:139–141PubMedCrossRefGoogle Scholar
  55. 55.
    Joyce AM, Burns DL, Marcello PW, Tronic B, Scholz FJ (2005) Capsule endoscopy findings in celiac disease associated enteropathy-type intestinal T-cell lymphoma. Endoscopy 37:594–596PubMedCrossRefGoogle Scholar
  56. 56.
    Toth E, Ohlsson B, Ljungberg O, Thorlacius H (2006) Celiac disease diagnosed using video capsule endoscopy in a patient with Crohn’s disease. Endoscopy 38:548PubMedCrossRefGoogle Scholar
  57. 57.
    Cellier C, Green PHR, Collin P, Murray J (2005) ICCE consensus for celiac disease. Endoscopy 37:1055–1059PubMedCrossRefGoogle Scholar
  58. 58.
    Cave D, Legnani P, de Franchis R, Lewis BS (2005) ICCE consensus for capsule retention. Endoscopy 37:1065–1067PubMedCrossRefGoogle Scholar
  59. 59.
    Leighton JA, Sharma VK, Srivathsan K, Heigh RI, McWane TL, Post JK, Robinson SR, Bazzell JL, Fleischer DE (2004) Safety of capsule endoscopy in patients with pacemakers. Gastrointest Endosc 59:567–569PubMedCrossRefGoogle Scholar
  60. 60.
    Ell C, Remke S, May A, Helou L, Henrich R, Mayer G (2002) The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding. Endoscopy 34:685–689PubMedCrossRefGoogle Scholar
  61. 61.
    Bouhnik Y, Coffin B, Moussaoui R, Oudghiri A, Rambaud JC (1998) Two way push videoenteroscopy in investigation of small bowel disease. Gut 43:280–284PubMedCrossRefGoogle Scholar
  62. 62.
    Mylonaki M, Fritscher-Ravens A, Swain P (2003) Wireless capsule endoscopy: a comparison with push enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleeding. Gut 52:1122–1126PubMedCrossRefGoogle Scholar
  63. 63.
    Rex DK, Lappas JC, Maglinte DD, Malczewski MC, Kopecky KA Cockerill EM (1989) Enteroclysis in the evaluation of suspected small bowel bleeding. Gastroenterology 97:58–60PubMedGoogle Scholar
  64. 64.
    Lo SK (2004) Capsule endoscopy in the diagnosis and management of inflammatory bowel disease. Gastrointest Endosc Clin N Am 14:179–193PubMedCrossRefGoogle Scholar
  65. 65.
    Maglinte DD, Kelvin FM, O’Connor K et al (1996) Current status of small bowel radiography. Abdominal imaging 21:247–257PubMedCrossRefGoogle Scholar
  66. 66.
    Nolan DJ, Traill ZC (1997) The current role of barium examination of the small intestine. Clin Radiol 52:809–820PubMedCrossRefGoogle Scholar
  67. 67.
    Saurin JC, Delvaux M, Vahedi K, Gaudin JL, Villarejo J, Florent C, Gay G, Ponchon T (2005) Clinical impact of capsule endoscopy compared to push enteroscopy: 1-year follow-up study. Endoscopy 37:318–323PubMedCrossRefGoogle Scholar
  68. 68.
    Lee SD, Cohen RD (2002) Endoscopy of the small bowel in inflammatory bowel disease. Gastrointest Endosc Clin N Am 12:485–493PubMedCrossRefGoogle Scholar
  69. 69.
    Rey JF, Ladas S, Alhassani A, Kuznetsov K, the ESGE Guidelines Committee (2006) European Society of Gastrointestinal Endoscopy (ESGE) Video capsule endoscopy: update to guidelines (May 2006). Endoscopy 38:1047–1053PubMedCrossRefGoogle Scholar
  70. 70.
    Yamamoto H, Sekine Y, Sato Y, Higashizawa T, Miyata T, Iino S, Ido K, Sugano K (2001) Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 53:216–220PubMedCrossRefGoogle Scholar
  71. 71.
    Hara AK, Leighton JA, Sharma VK, Heigh RI, Fleischer DE (2005) Imaging of small bowel disease: comparison of capsule endoscopy, standard endoscopy, barium examination, and CT. RadioGraphics 25:697–718PubMedCrossRefGoogle Scholar
  72. 72.
    Lewis BS, Eisen GM, Friedman S (2005) A pooled analysis to evaluate results of capsule endoscopy trials. Endoscopy 37:960–965PubMedCrossRefGoogle Scholar
  73. 73.
    Sturniolo GC, Di Leo V, Vettorato MG, De Boni M, Lamboglia F, De Bona M, Bellumat A, Martines D, D’Inca R (2006) Small bowel exploration by wireless capsule endoscopy: results from 314 procedures. Am J Med 119:341–347PubMedCrossRefGoogle Scholar
  74. 74.
    Eliakim R (2004) Wireless capsule video endoscopy: three years of experience. World J Gastroenterol 10:1238–1239PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Department of Diagnostic RadiologyMalmö University HospitalMalmoeSweden
  2. 2.Department of GastroenterologyRikshospitalet University HospitalOsloNorway

Personalised recommendations