| Invited Lecture(JGES) |
| Sat. November 23rd 14:00 - 14:30 Room 11: Portopia Hotel South Wing Topaz |
| The current status of capsule endoscopy in Europe | |||
| Jean-Francois Rey | |||
| Institute Arnault Tzanck | |||
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| Capsule endoscopy of small intestine was a breakthrough in digestive tract diagnosis when it was introduced in clinical practice in the early 2001 by Given Imaging. It has been introducing in Europe in 2002. Since then multiple improvements has been achieved and from the small bowel the capsule technology has been extended to colon, stomach and Esophagus leading to a pancapsule endoscopy. Since its early development multiple improvements has been achieved on mechanical parts (better sensor resolution, wider angle of view, longer lasting battery…). Reading time was very consuming but new software using mathematic algorithm reduce reading by at least 40%. more recent use of computer aid endoscopy could lead to computer detection of small angiodysplasia or minute ulcerations. On clinical point of view small bowel capsule is now the gold standard for any suspicion of small bowel disease. reimbursement is a crucial issue due to the cost of the device .in most west countries the reimbursement is strictly related to clinical indications mainly obscure GI bleeding after normal gastroscopy and colonoscopy or suspected crohn disease with clinical assessment et biological abnormalities irritable bowel syndrome is excluded. ESGE guideline explain clearly the use and misuse of small bowel capsule. Colon capsule is developed by Medtronic as a colonic examination went colonoscopy is impossible for technical raison or patient condition’s protocol is very demanding as it requires a very efficient bowl cleansing and the use of booster when the capsule reach the caecum. clinical outcome is closed to colonoscopy for detection of polys but the main drawback is related to the absence of therapeutic possibilities. Due to the clinical benefit of Hight resolution video colonoscopy the use of colon capsule is very limited in daily practice. France healthcare system reimburse colon capsule for patient with technically impossible colonoscopy or contraindications. Usual capsule is not adequate to examine the large gastric cavity. Its why Olympus-Siemens carried on the first clinical trial with a magnetic guided gastric capsule. the result was encouraging but the large MR system was costly and difficult to insert in endoscopy unit. Ankon company is now developing a magnetic capsule with a small module. this capsule I already largely used in China by physician or assistants. And new start a clinical trial in order to obtain reimbursement It could be future a non-invasive method for gastric screening or diagnosis when biopsies are not mandatories. By the time being Esophagus is a challenge: passive capsule pass through oesophagus rapidly but a capsule link to a string is now under investigation allowing the capsule to be used for Esophagus examination before to release in stomach. In summary Capsule endoscopy is a new non-invasive tool, gold standard for small bowel diagnosis with the current possibility of panendoscopy capsule with recent new capsules. |
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