Capsule endoscopy of the small bowel

Abstract

Capsule endoscopy (CE) is a first line small bowel investigative modality which provides more sensitive mucosal imaging than comparators. It is a non-invasive, non-irradiating tool well tolerated by patients. The risk of retention of the capsule can be minimised by ensuring luminal patency using the Agile patency device. Research continues into how to minimise missed pathology and variability in the identification of pathology or interpretation of images. The consensus is that bowel preparation using laxatives improves visibility and diagnostic yield. Research includes the development of image recognition software, both to eliminate sequentially identical images to improve viewing speed and to select or enhance images likely to represent pathology. However, careful reading by experienced capsule endoscopists remains the benchmark. This should be performed at a speed comfortable to the viewer, probably at a maximum of 15 frames per second. Some prior experience of endoscopy appears to be helpful for novice capsule endoscopists and formal training on a hands-on training course seems to improve pathology recognition, for novices and for those with CE experience.

Keywords: Capsule endoscopy (CE); complications; indication; reading; small bowel; software.

Figure 1

The OdoCapsule: extended legs stabilize the capsule during transit and rotating wheels measure distance travelled.

Figure 2

The gastrointestinal diagnostic hub: video data downloaded following capsule endoscopy in the community, read, reported and returned with advice to the referring clinician.