Practice

Gastrointestinal capsule endoscopy: from tertiary centres to primary care

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7540.528 (Published 02 March 2006) Cite this as: BMJ 2006;332:528
  1. Reena Sidhu, specialist registrar in gastroenterology (reena_sidhu@yahoo.com)1,
  2. David S Sanders, consultant gastroenterologist1,
  3. Mark E McAlindon, consultant gastroenterologist1
  1. 1 Royal Hallamshire Hospital, Sheffield S10 2JF
  1. Correspondence to: R Sidhu
  • Accepted 20 January 2006

The first endoscope introduced by Bruening in 1907 was a rigid instrument that allowed inspection of the upper gastrointestinal tract under a general anaesthetic.w1 Forty years later the first flexible fibreoptic instrument allowed procedures to be done under local anaesthetic or light sedation. It took a further 20 years for the technological evolution of the first colonoscope. A major advance occurred in 1999, when capsule endoscopy enabled complete visualisation of the small bowel.w2 A capsule is swallowed and propelled through the gastrointestinal tract by the action of peristalsis. It contains an imaging device, which transmits images of the intestine to sensors on the abdominal wall.

Fig 1

A capsule endoscope

Historically the small bowel was considered technically difficult to examine because of its length (3-5 metres), location, and tortuosity.w3 Previously the small bowel could be partly assessed by a push enteroscope, which is longer (about 2 metres) than a standard gastroscope and therefore allows examination of up to 80-120 cm beyond the ligament of Treitz (anatomically the duodenojejunal flexure), while intraoperative enteroscopy required a general anaesthetic and laparotomy. Barium follow through (small bowel meal) and enteroclysis (double contrast small bowel follow through) allow indirect examination of the small bowel but have a low diagnosis rate.1 w4 w5

Given the limitations of these other tests, there has been a surge in investigations on the practical diagnostic ability and clinical utility of capsule endoscopy.

Summary points

Capsule endoscopy—a novel method of imaging the small bowel—is safe and can be performed on an outpatient basis in both primary and secondary care

It has a higher positive diagnosis rate in the detection of small bowel pathology than conventional small bowel investigations

Capsule endoscopy can be used to investigate patients with obscure gastrointestinal bleeding and negative results on upper and lower gastrointestinal endoscopy

Sources and selection criteria

We performed …

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