Videocapsule Endoscopy: Fiction becoming fact

The recent introduction of videocapsule endoscopy has provided gastroenterologists a complete and simple endoscopic technique for endoscopic evaluation of the entire small intestine. Previously, the proximal part of the small intestine could be examined using push enteroscopy and the terminal ileum could be evaluated at ileocolonoscopy. Only an intra-operative enteroscopy offered the possibility to examine the entire small intestine. The latter is however a very invasive procedure as a laparotomy is necessary to allow the surgeon to move the small bowel over the endoscope. Videocapsule endoscopy (VCE) is a new technique to examine the small intestine in a non-invasive way. A capsule with a length of 26 mm. and a width of 11 mm. is swallowed by the patient and is propelled by small intestinal peristalsis. It obtains two digital images per second which are transmitted to a data recorder. At the end of the procedure the images are downloaded to a working station where they can be reviewed as a movie. The first papers on the results of VCE were very promising. The entire small intestine was examined in 85% of the patients and a diagnosis was established in 55-85% of the patients. The diagnostic yield in these first studies could be overestimated by the initial strong case selection, and the clinical relevance of the VCE fi ndings remained unclear. It can be expected that the proportion of patients with clinically relevant VCE findings will be lower when the technique is more widely available. Capsule endoscopy nevertheless appears to be superior to push enteroscopy and radiological examination of the small intestine. Further research is needed on the optimal preparation, clinical consequences of VCE findings and possible other indications for VCE.

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