Intest Res. 2016 Jan; 14(1): 21–29. Published online 2016 Jan 26. doi: 10.5217/ir.2016.14.1.21 Papers PMCID: PMC4754518 PMID: 26884731 Current status and future perspectives of capsule endoscopy Hyun Joo Song1 and Ki-Nam Shim2 Author information Article notes Copyright and License information Disclaimer This article has been cited by other articles in PMC. Go to: Abstract Small bowel capsule endoscopy (CE) was first introduced 15 years ago, and a large amount of literature has since been produced, focused on its indication, diagnostic yields, and safety. Guidelines that have made CE the primary diagnostic tool for small bowel disease have been created. Since its initial use in the small bowel, CE has been used for the esophagus, stomach, and colon. The primary indications for small bowel CE are obscure gastrointestinal bleeding, unexplained iron deficiency anemia, suspected Crohn's disease, small bowel tumors, nonsteroidal anti-inflammatory drug enteropathy, portal hypertensive enteropathy, celiac disease, etc. Colon CE provides an alternative to conventional colonoscopy, with possible use in colorectal cancer screening. Guidelines for optimal bowel preparation of CE have been suggested. The main challenges in CE are the development of new devices with the ability to provide therapy, air inflation for better visualization of the small bowel, biopsy sampling systems attached to the capsule, and the possibility of guiding and moving the capsule by an external motion controller. We review the current status and future directions of CE, and address all aspects of clinical practice, including the role of CE and long-term clinical outcomes. Keywords: Capsule endoscopy, Intestine, small, Current, Future Go to: INTRODUCTION Wireless capsule endoscopy (CE) was invented by Gavriel Iddan in the mid-1990s.1 Since its introduction in 2000, CE has revolutionized the diagnosis and treatment of various small bowel diseases. The field of CE has made tremendous advances over the past 15 years, and gastroenterologists have become skilled at advancing flexible video endoscopes into the upper and lower portions of the gastrointestinal (GI) tract. Small bowel CE is the best method for examining the full surface of the small bowel and is optimal for small bowel endoscopic imaging.2 The third-generation capsule was released in August 2014 (PillCam® SB3; Given Imaging, Yokneam, Israel). Other small-bowel capsules have been introduced since 2006 in Korea (MiroCam®; IntroMedic, Seoul, Korea), Japan (EndoCapsule®; Olympus, Tokyo, Japan) and China (OMOM®; Jinshan Science and Technology Company, Chongqing, China).3 A comparison among currently available CE devices is shown in Table 1.4 In a direct comparison in 83 patients, the PillCam and MiroCam showed similar efficacy for obscure gastrointestinal bleeding (OGIB) diagnosis. The study showed satisfactory diagnostic agreement between the two systems (κ=0.66).5 A similar comparison was performed between the MiroCam and the EndoCapsule in 50 patients; no statistical difference was found in their performance and the combined diagnostic yield was 58%.6 Given Imaging has also developed a double-headed esophageal capsule (PillCam Eso3) and a double-headed colonic capsule (PillCam Colon 2). Table 1 Comparison Between Currently Available Capsule Endoscopy Systems Capsule endoscopy PillCam SB3® Given Imaging MiroCam® Intromedic Company EndoCapsule® Olympus Japan OMOM® Jinshan Science and Technology Size (mm) Length 26.2 24.5 26.0 27.9 Diameter 11.4 10.8 11.0 13.0 Weight (g) 3.00 3.25-4.70 3.50 6.00 Battery life (hr) 8 or longer (max. 15) 12 8 or longer 6-8 or longer Resolution 340×340 30% better than SB2 320×320 512×512 640×480 Frames per second (fps) 2 or 2-6 3 3 2 Field of view (°) 156 170 145 140 Communication Radio frequency communication Human body communication Radio frequency communication Radio frequency communication Open in a separate window We review the current status and future directions of CE by addressing all aspects of clinical practice, including the role of CE according to 2013 and 2015 Korean Society of Gastroinestinal Endoscopy7,8,9and 2015 European Society of Gastrointestinal Endoscopy (ESGE) guidelines,10 as well as long-term clinical outcomes with special reference to Korean multicenter studies. Go to: INDICATIONS FOR SMALL BOWEL CE The major indications for small bowel CE are OGIB, unexplained iron deficiency anemia (IDA), CD, small bowel tumors, NSAID-induced enteropathy, portal hypertensive enteropathy (PHE), celiac disease, inherited polyposis syndromes, chronic abdominal pain, etc. (Table 2). The contraindications for CE are also presented in Table 2. Table 2 Indications and Contraindications for Capsule Endoscopy Indications Contraindications Obscure gastrointestinal bleeding Absolute contraindications Iron deficiency anemia Clinical or radiographic evidence of relevant bowel obstruction CD Extensive and acute CD of the small bowel with obstruction Small bowel tumors Intestinal pseudo-obstruction NSAID-induced enteropathy Relative contraindications Portal hypertensive enteropathy Cardiac pacemakers or other implanted electromedical devices Celiac disease Dysphagia Inherited polyposis syndromes Previous abdominal or pelvic surgery Unexplained chronic abdominal pain Pregnancy Extensive intestinal diverticulosis 1. OGIB OGIB refers to GI bleeding of undetermined origin that persists or recurs despite negative upper GI endoscopy or colonoscopy. Approximately 5% of GI bleeding cases are attributed to OGIB.11 OGIB originates in the small bowel in more than 80% of cases.12 It is "overt" when there are signs of bleeding such as hematochezia or melena; it is "occult" with a positive fecal occult blood test, or when IDA is presumed to be caused by GI blood loss.13 The Korean Gut Image Study Group published guidelines for OGIB in 2013.7 These guidelines proposed methods for diagnosis and management of OGIB (Fig. 1). According to the guidelines, CE is an effective initial diagnostic method for evaluating patients (strong recommendation, moderate quality evidence). Diagnostic yield is improved by performing CE early in OGIB (strong recommendation, moderate quality evidence). The 2015 ESGE guidelines also recommends performing small bowel CE as soon as possible after a bleeding episode, ideally within 14 days, in patients with OGIB (strong recommendation, moderate quality evidence).10
