The availability of wireless capsule endoscopy (CE) has completely revolutionized the approach to patients with small bowel disease. Small bowel CE is now recommended by most international guidelines as the first-line investigation of obscure GIB after negative upper and lower GI endoscopy. Apart from SB bleeding, CE is also useful for the assessment of unexplained iron deficiency anemia and surveillance of SB polyps in patients with polyposis syndrome. The colon capsule endoscopy (CCE) is designed for direct visualization of the colon. The performance of the second generation of CCE has been shown in an international multi-centre trial using optical colonoscopy and segmental unbinding as the reference. It was shown that the sensitivity in identifying subjects with any adenoma (6mm or larger) was 91% and the specificity was 83%. There are also recent data to suggest that CCE can be used in the monitoring of mucosal inflammation in patients with inflammatory bowel disease (IBD), both in ulcerative colitis and in Crohn’s disease. However, the CCE is not designed for pan-enteric examination since considerable proportion of small bowel images were omitted during video compilation. To address the increasing need of pan-enteric examination as in patients with Crohn’s disease, the Pillcam Crohn is a recent addition to the existing CE system. This specific capsule endoscope is similar to the existing CCE with two cameras on each end which captures at a frame rate of 35 frames per second and there is no sleep mode. The video compilation system is also optimized for small bowel mucosal lesion detection. Preliminary results showed that it is superior to ileocolonoscopy for detection of small bowel lesions in patients with Crohn’s disease and can assess mucosal healing in patients with Crohn’s disease.
One of the main limitations of all CE system is the inability to manipulate the capsule endoscope while inside the human body. The recently available magnetic-assisted capsule endoscopy system has been shown to be useful for the detection of gastric lesions, particularly in patients considered high risk for gastroscopy. Future studies are needed to test the feasibility of manipulation of the capsule the small bowel and colon as well as the use of artificial intelligence on automated lesion detection. |
