Capsule Endoscopy: A Comprehensive Review

Abstract

Until a few years ago, the small bowel was an organ which was very difficult to explore with the available endoscopic, radiological and nuclear medicine techniques due to anatomical (i.e. distance from external orifices, length) and physiological (i.e. active peristalsis) reasons. In routine practice, only the last few centimeters of the ileum was accessible to retrograde visualization by ileo-colonoscopy. Exploration from the proximal side by push, sonde or intra-operative enteroscopy were invasive procedures that did not always allow us to visualize the lesions in the small bowel (Galmi che et al.,2008). Sonde enteroscopy had been abandoned in the 90’s because it was a tedious technique (long duration of the procedure) and it had several technical limitations. Push enteroscopy is limited by the depth of insertion of the scope and is poorly tolerated. Intra-operative enteroscopy is the most effective of these techniques, but it is the most invasive with a significant percentage of adverse side effects (Rondonotti et al., 2007). The concept for small bowel capsule was developed independently by two groups. Dr. Paul Swain, a British gastroenterologist demonstrated the first live transmissions in 1996 with the broadcast of a pig's stomach. In 1997, he collaborated with Dr. Gavriel Iddan, a mechanical engineer working with the Israel Ministry of Defense(Appleyard et al.,2001;Meron,2000;Swain et al.,1996). Successful animal trials were conducted and first published in 2000. (Swain et al.,1996) Human studies followed and the use of capsule endoscopy (CE) in clinical trials was first published in 2001. (Kornbluth et al.,2004) Since the emergence of CE, more than 1000000 capsules have been swallowed worldwide and nearly 1000 peer reviewed publications have appeared in the literature. This article reviews the fundamental of wireless capsule endoscopy. Special attention is paid to the indications, benefits and drawbacks of the technique, as well as to the strengths and limitations of clinical data available to the date.