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Current Controversies Concerning Capsule Endoscopy

  • CURRENT CLINICAL CONTROVERSY
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Abstract

Video capsule endoscopy became a reality in 2001. This device enabled us to directly view the mucosa of the small intestine for the first time. The main indications for the video capsule remain the detection of small intestinal bleeding and iron deficiency anemia, diagnosis and management of Crohn’s disease, and detection of tumors. The device is extraordinarily safe and can be used in the very young to the very old. However, there remain several areas of controversy and difficulty. These are covered in this article and include details of indications and contraindications, whether to prepare patients, whether or not to use simethicone and prokinetics. Detection of location of the capsule remains a major engineering challenge. Reading the videos reliably and quickly remains challenging. However, artificial intelligence and machine learning are already on the horizon to provide assistance. New uses for capsule endoscopy promise more accurate diagnosis and hence improved management of acute gastrointestinal bleeding. The colon capsule may eventually help those who refuse conventional colonoscopy, and robotically controlled capsules may be helpful in screening for serious disease in patients with upper abdominal complaints. The advent of the broadening use of video capsule endoscopy is, though it will be controversial, embraced by some and derided by others; such is the nature of technological development. In the long run, if the use of the video capsule, based on sound evidence-based studies, can be shown to improve the care of our patients and reduce the cost of health care, its use will continue to expand.

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References

  1. Lewis BS, Swain P. Capsule endoscopy in the evaluation of patients with suspected small intestinal bleeding: results of a pilot study. Gastrointest Endosc. 2002;56:349–353.

    PubMed  Google Scholar 

  2. Zwinger LL, Siegmund B, Stroux A, et al. CapsoCam SV-1 versus PillCam SB 3 in the detection of obscure gastrointestinal bleeding: results of a prospective randomized comparative multicenter study. J Clin Gastroenterol. 2019;53:e101–e106.

    CAS  PubMed  Google Scholar 

  3. Shin JK, Cheon JH, Lim JS, et al. Long-term outcomes of obscure gastrointestinal bleeding after CT enterography: does negative CT enterography predict lower long-term rebleeding rate? J Gastroenterol Hepatol. 2011;26:901–907.

    PubMed  Google Scholar 

  4. Limsrivilai J, Srisajjakul S, Pongprasobchai S, Leelakusolvong S, Tanwandee T. A prospective blinded comparison of video capsule endoscopy versus computed tomography enterography in potential small bowel bleeding: clinical utility of computed tomography enterography. J Clin Gastroenterol. 2017;51:611–618.

    PubMed  Google Scholar 

  5. Sung JJY, Tang RSY, Ching JYL, Rainer TH, Lau JYW. Use of capsule endoscopy in the emergency department as a triage of patients with GI bleeding. Gastrointest Endosc. 2016;84:907–913.

    PubMed  Google Scholar 

  6. Marya NB, Jawaid S, Foley A, et al. A randomized controlled trial comparing efficacy of early video capsule endoscopy with standard of care in the approach to nonhematemesis GI bleeding (with videos). Gastrointest Endosc. 2019;89:33.

    PubMed  Google Scholar 

  7. Dionisio PM, Gurudu SR, Leighton JA, et al. Capsule endoscopy has a significantly higher diagnostic yield in patients with suspected and established small-bowel crohn’s disease: a meta-analysis. Am J Gastroenterol. 2010;105:1240–1248.

    PubMed  Google Scholar 

  8. Pasha SF, Pennazio M, Rondonotti E, et al. Capsule retention in Crohn’s disease: a meta-analysis. Inflamma Bowel Dis. 2019. https://doi.org/10.1093/ibd/izz083.

    Article  Google Scholar 

  9. Cauned-Alvarez A, Romero-Vazquez J, Gomez-Rodriguez B, Pellicer-Bautista F, Herrerias-Gutteriez J. Evaluation of a new double headed biodegradable device (AGILE Patency Capsule) for detecting functional patency of the small intestine. A prospective clinical trial. In: Proceedings of the 5th International Conference on Capsule. Endoscopy; 2006.

  10. Postgate AJ, Will OC, Fraser CH, Fitzpatrick A, Phillips RKS, Clark SK. Capsule endoscopy for the small bowel in juvenile polyposis syndrome: a case series. Endoscopy. 2009;41:1001–1004.

    CAS  PubMed  Google Scholar 

  11. Schulmann K, Hollerbach S, Kraus K, et al. Feasibility and diagnostic utility of video capsule endoscopy for the detection of small bowel polyps in patients with hereditary polyposis syndromes. Am J Gastroenterol. 2005;100:27–37.

    PubMed  Google Scholar 

  12. Spada C, Riccioni M-E, Urgesi R, Costamagna G. Capsule endoscopy in celiac disease. World J Gastroenterol. 2008;14:4146–4151.

    PubMed  PubMed Central  Google Scholar 

  13. Fry LC, Carey EJ, Shiff AD, et al. The yield of capsule endoscopy in patients with abdominal pain or diarrhea. Endoscopy. 2006;38:498–502.

    CAS  PubMed  Google Scholar 

  14. Luján-Sanchis M, Sanchis-Artero L, Larrey-Ruiz L, et al. Current role of capsule endoscopy in Crohn’s disease. World J Gastrointest Endosc. 2016;8:572–583.

    PubMed  PubMed Central  Google Scholar 

  15. Song HJ, Moon JS, Jeon SR, et al. Diagnostic yield and clinical impact of video capsule endoscopy in patients with chronic diarrhea: a Korean multicenter CAPENTRY study. Gut Liver. 2017;11:253–260.

    PubMed  Google Scholar 

  16. Enns RA, Hookey L, Armstrong D, et al. Clinical practice guidelines for the use of video capsule endoscopy. Gastroenterology. 2017;152:497–514.

    PubMed  Google Scholar 

  17. Mustafa BF, Samaan M, Langmead L, Khasraw M. Small bowel video capsule endoscopy: an overview. Expert Rev Gastroenterol Hepatol. 2013;7:323–329.

    CAS  PubMed  Google Scholar 

  18. Bandorski D, Höltgen R, Stunder D, Keuchel M. Capsule endoscopy in patients with cardiac pacemakers, implantable cardioverter defibrillators and left heart assist devices. Ann Gastroenterol. 2014;27:3–8.

    PubMed  PubMed Central  Google Scholar 

  19. Marshall CA, Cave DR. Preparation for video capsule endoscopy: a clear choice? Gastrointest Endosc. 2017;85:194–195.

    PubMed  Google Scholar 

  20. Hookey L, Louw J, Wiepjes M, et al. Lack of benefit of active preparation compared with a clear fluid–only diet in small-bowel visualization for video capsule endoscopy: results of a randomized, blinded, controlled trial. Gastrointest Endosc. 2017;85:187–193.

    PubMed  Google Scholar 

  21. Rokkas T, Papaxoinis K, Triantafyllou K, Pistiolas D, Ladas SD. Does purgative preparation influence the diagnostic yield of small bowel video capsule endoscopy?: a meta-analysis. Am J Gastroenterol. 2009;104:219–227.

    CAS  PubMed  Google Scholar 

  22. Niv Y. Efficiency of bowel preparation for capsule endoscopy examination: a meta-analysis. World J Gastroenterol. 2008;14:1313–1317.

    PubMed  PubMed Central  Google Scholar 

  23. Rosa BJF, Barbosa M, Magalhães J, Rebelo A, Moreira MJ, Cotter J. Oral purgative and simethicone before small bowel capsule endoscopy. World J Gastrointest Endosc. 2013;5:67–73.

    PubMed  PubMed Central  Google Scholar 

  24. Albert J, Göbel C-M, Leßke J, Lotterer E, Nietsch H, Fleig WE. Simethicone for small bowel preparation for capsule endoscopy: a systematic, single-blinded, controlled study. Gastrointest Endosc. 2004;59:487–491.

    PubMed  Google Scholar 

  25. Fang Y-H, Chen C-X, Zhang B-L. Effect of small bowel preparation with simethicone on capsule endoscopy. J Zhejiang Univ Sci B. 2009;10:46–51.

    PubMed  PubMed Central  Google Scholar 

  26. Chen HB, Huang Y, Chen SY, et al. Small bowel preparations for capsule endoscopy with mannitol and simethicone: a prospective, randomized, clinical trial. J Clin Gastroenterol. 2011;45:337–341.

    CAS  PubMed  Google Scholar 

  27. Esaki M, Matsumoto T, Kudo T, Yanaru-Fujisawa R, Nakamura S, Iida M.  Bowel preparations for capsule endoscopy: a comparison between simethicone and magnesium citrate. Gastrointest Endosc. 2009;69:94–101.

    PubMed  Google Scholar 

  28. Krijbolder MS, Grooteman KV, Bogers SK, de Jong DJ. Addition of simethicone improves small bowel capsule endoscopy visualisation quality. Neth J Med. 2018;76:27–31.

    CAS  PubMed  Google Scholar 

  29. Laursen SB, Leontiadis GI, Stanley AJ, Moller MH, Hansen JM, Schaffalitzky de Muckadell OB. Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study. Gastrointest Endosc. 2017;85:936–944e3.

    PubMed  Google Scholar 

  30. Alexandrino G, Domingues TD, Carvalho R, Costa MN, Lourenço LC, Reis J. Endoscopy timing in patients with acute upper gastrointestinal bleeding. Clin Endosc. 2019;52:47–52.

    PubMed  Google Scholar 

  31. Hartmann D, Schilling D, Bolz G, et al. Capsule endoscopy versus push enteroscopy in patients with occult gastrointestinal bleeding. Z Gastroenterol. 2003;41:377–382.

    CAS  PubMed  Google Scholar 

  32. Vlachogiannakos J, Papaxoinis K, Viazis N, et al. Bleeding lesions within reach of conventional endoscopy in capsule endoscopy examinations for obscure gastrointestinal bleeding: is repeating endoscopy economically feasible? Dig Dis Sci. 2011;56:1763–1768.

    PubMed  Google Scholar 

  33. Yamada A, Watabe H, Kobayashi Y, Yamaji Y, Yoshida H, Koike K. Timing of capsule endoscopy influences the diagnosis and outcome in obscure-overt gastrointestinal bleeding. Hepatogastroenterology. 2012;59:676–679.

    PubMed  Google Scholar 

  34. Singh A, Marshall C, Chaudhuri B, et al. Timing of video capsule endoscopy relative to overt obscure GI bleeding: implications from a retrospective study. Gastrointest Endosc. 2013;77:761–766.

    PubMed  Google Scholar 

  35. Gomes C, Pinho R, Rodrigues A, et al. Impact of the timing of capsule endoscopy in overt obscure gastrointestinal bleeding on yield and rebleeding rate—is sooner than 14 d advisable? World J Gastrointest Endosc. 2018;10:74–82.

    PubMed  PubMed Central  Google Scholar 

  36. Hakimian S, Jawaid S, Guilarte-Walker Y, Mathew J, Cave D. Video capsule endoscopy as a tool for evaluation of obscure overt gastrointestinal bleeding in the intensive care unit. Endosc Int Open. 2018;6:E989–E993.

    PubMed  PubMed Central  Google Scholar 

  37. Koulaouzidis A, Iakovidis DK, Yung DE, et al. Novel experimental and software methods for image reconstruction and localization in capsule endoscopy. Endosc Int Open. 2018;6:E205–E210.

    PubMed  PubMed Central  Google Scholar 

  38. Xia Y, Zhang L, Lu K, Wu L. 3D magnetic-resonance-coupling (MRC) localization of wireless capsule endoscopy. In: 2016 IEEE Conference on Electromagnetic Field Computation (CEFC); 2016.

  39. Marya N, Karellas A, Foley A, Roychowdhury A, Cave D. Computerized 3-dimensional localization of a video capsule in the abdominal cavity: validation by digital radiography. Gastrointest Endosc. 2014;79:669–674.

    PubMed  Google Scholar 

  40. Karargyris A, Koulaouzidis A. Capsule-odometer: a concept to improve accurate lesion localisation. World J Gastroenterol. 2013;19:5943–5946.

    PubMed  PubMed Central  Google Scholar 

  41. De Leusse A, Landi B, Edery J, et al. Video capsule endoscopy for investigation of obscure gastrointestinal bleeding: feasibility, results, and interobserver agreement. Endoscopy. 2005;37:617–621.

    PubMed  Google Scholar 

  42. Lai LH, Wong GL, Lau JY, Sung JJ, Leung WK. Inter-observer variations on interpretation of capsule endoscopy. Gastrointest Endosc. 2005;61:AB173.

    Google Scholar 

  43. Jang BI, Lee SH, Moon JS, et al. Inter-observer agreement on the interpretation of capsule endoscopy findings based on capsule endoscopy structured terminology: a multicenter study by the Korean Gut Image Study Group. Scand J Gastroenterol. 2010;45:370–374.

    PubMed  Google Scholar 

  44. Jensen MD, Nathan T, Kjeldsen J. Inter-observer agreement for detection of small bowel Crohn’s disease with capsule endoscopy. Scand J Gastroenterol. 2010;45:878–884.

    PubMed  Google Scholar 

  45. Biagi F, Rondonotti E, Campanella J, et al. Video capsule endoscopy and histology for small-bowel mucosa evaluation: a comparison performed by blinded observers. Clin Gastroenterol Hepatol. 2006;4:998–1003.

    PubMed  Google Scholar 

  46. Cave DR, Fleischer DE, Leighton JA, et al. A multicenter randomized comparison of the Endocapsule and the Pillcam SB. Gastrointest Endosc. 2008;68:487–494.

    PubMed  Google Scholar 

  47. Pioche M, Gaudin JL, Filoche B, et al. Prospective, randomized comparison of two small-bowel capsule endoscopy systems in patients with obscure GI bleeding. Gastrointest Endosc. 2011;73:1181–1188.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, The University of Massachusetts, 55 Lake Avenue North, Worcester, MA, 01655, USA

    David R. Cave, Shahrad Hakimian & Krunal Patel

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  1. David R. Cave
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  2. Shahrad Hakimian
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  3. Krunal Patel
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Correspondence to David R. Cave.

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David Cave: Research funding from the Olympus Corporation of America, and Medtronic. Shahrad Hakimian and Krunal Patel have no conflict of interest.

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Cave, D.R., Hakimian, S. & Patel, K. Current Controversies Concerning Capsule Endoscopy. Dig Dis Sci 64, 3040–3047 (2019). https://doi.org/10.1007/s10620-019-05791-4

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