Abstract
The small bowel is the longest organ within the gastrointestinal tract. The emergence of small bowel capsule endoscopy (SBCE) over the last 20 years has revolutionized the investigation and diagnosis of small bowel pathology. Its utility as a non-invasive and well-tolerated procedure, which can be performed in an outpatient setting, has made it a valuable diagnostic tool. The indications for SBCE include obscure gastrointestinal bleeding, small bowel Crohn’s disease, and, less frequently for screening in polyposis syndromes, celiac disease, or other small bowel pathology. Currently, there are several small bowel capsules on the market from different manufacturers; however, they share many technological features. The European Society of Gastrointestinal Endoscopy (ESGE) only recently developed a set of key quality indicators to guide quality standards in this area. Many of the technical aspects of capsule endoscopy still feature a degree of uncertainty in terms of optimal performance. Incomplete studies due to slow transit through the bowel, poor imaging secondary to poor preparation, and the risk of capsule retention remain frustrations in its clinical utility. Capsule review is a time-consuming process; however, artificial intelligence and machine learning offer opportunities to improve this. This narrative review examines our current standing in a number of these aspects and the potential to further the application of SBCE in order to maximize its diagnostic utility.
Highlights
The small bowel is the longest organ within the gastrointestinal tract
Our study suggests that an Fecal calprotectin (FC) level > 194 μg/g may be a useful filter test in patients referred for small bowel capsule endoscopy (SBCE) with either suspected or known small-bowel Crohn’s disease (CD) and could help to prioritize referrals
There is a benefit to early SBCE, and this needs to be considered in the triage criterion used for an often oversubscribed service
Summary
The small bowel is the longest organ within the gastrointestinal tract. Until the turn of the century, it was an obscure area in terms of endoscopic imaging, limited by the distance to which enteroscopes could be pushed into the small bowel. Incomplete studies due to slow transit through the bowel, poor imaging secondary to poor preparation, and the risk of capsule retention, continue to frustrate its clinical application. Another challenge faced in SBCE is the risk of missed pathology due to the subtle nature of lesions, as well as the often fleeting glimpses of the pathology obtained. This narrative review analyzes the current state of SBCE application and assesses potential opportunities to develop the application of SBCE in order to maximize its diagnostic utility. We must make sure that we maximize the diagnostic utility of this valuable resource through the careful selection of patients and optimal timing of the test
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