Endoscopia capsular

CliniCal Review
SCienCe, mediCine, and the futuRe

For the full versions of these articles see bmj.com

Capsule endoscopy
Andrea Moglia,1 Andrea Pietrabissa,1 2 Alfred Cuschieri3 4
EndoCAS, Center for Computer Assisted Surgery, University of Pisa, 56124 Pisa, Italy 2 Department of Oncology, Transplantation and New Technology in Medicine, University of Pisa 3 Institute for Medical Scienceand Technology, University of Dundee, Dundee Medipark, Dundee DD2 1FD 4 Scuola Superiore Sant’Anna di Studi Universitari, Piazza Martiri della Libertà 33, 56127, Pisa, Italy Correspondence to: A Moglia andrea.moglia@endocas.org
1

Capsule endoscopy was unveiled at Digestive Disease Week 2000 in San Diego, California, USA, by Paul Swain, gastroenterologist at Imperial College St Mary’s Hospital,London, and Given Imaging, a Yoqneam (Israel) company, as the product of collaborative research and development activities between the two groups.1 The past few years have seen advances in this technology, which is now part of established clinical practice in North America, Europe, the Far East, and Australia, particularly for imaging the small bowel. This article describes current clinicalapplications of capsule endoscopy and looks at future developments.
what is capsule endoscopy? Capsule endoscopy is performed by ingestion of a small (26×11 mm) disposable battery powered pill containing a complementary metal oxide semiconductor camera (fig 1), which provides a field of view of 156°, a variable depth of view (1-30 mm), and a resolution of 0.1 mm. Four light emitting diodes illuminatethe lumen of the bowel. Once swallowed by the patient, images of the gastrointestinal tract are acquired, transmitted externally by radiofrequency to a portable storage unit, and downloaded to a workstation. Capsule endoscopy hardware and software cost $22 495 (£13 650; €15 710) and the disposable capsule costs $450. A large retrospective multicentre study identified possible problems with thistechnique. They include failure to activate the device and to download the images to the workstation in 8.6% of cases, difficulty or inability to swallow the pill (1.5%), delayed gastric emptying (4.1%), failure to reach the ileocaecal valve (17.3%), and capsule retention (1.9%).2

Cite this as: BMJ 2009;339:b3420 doi: 10.1136/bmj.b3420

fig 1 | Capsule endoscopy devices from Given Imaging:PillCam SB2 for small intestine, PillCam COLON for large bowel, and PillCam ESO for oesophagus. Source: Given Imaging

SummaRy pointS
Capsule endoscopy requires patients to ingest a vitamin sized pill containing a camera that provides images of the gastrointestinal mucosa Capsule endoscopy is complementary to double balloon endoscopy for detecting obscure gastrointestinal bleeding and smallintestinal tumours Oesophageal capsule endoscopy is a safe alternative to upper gastrointestinal endoscopy in the surveillance of patients with Barrett’s oesophagus, although cost may limit its use Colonic capsule endoscopy may be useful in the detection of colorectal cancer when colonoscopy is incomplete or contraindicated Magnetically guided capsules may be useful in cystoscopy and as the imagingplatform for natural orifice transluminal endoscopic surgery Technological challenges for the next generation of devices include reducing component size, improving power management, and introducing capsule locomotion
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Several studies have investigated various bowel preparations to improve visualisation of the small intestine and the use of prokinetics to shorten transit times. However, theoptimal preparation remains to be determined.3 Patients must fast for eight to 12 hours before the procedure; they are allowed to drink after two hours and eat after four. 3 The capsule is expelled naturally after 24-48 hours in the patient’s stool.
what are the clinical applications of capsule endoscopy? The European Society of Gastrointestinal Endoscopy, the British Society of Gastroenterology, the...