Gastrointestinal capsule endoscopy: from tertiary centres to primary careBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7540.528 (Published 02 March 2006) Cite this as: BMJ 2006;332:528
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We read with interest the article by Dr. McAlindon and his colleagues
in the BMJ dated the 04/03/2006  on the role of capsule endoscopy in the
investigation of small bowel diseases. This is a new modality in the
investigation of the gastrointestinal diseases mainly of the small bowel,
but the technique is in evolution. We have seen two recent cases in which capsule endoscopy resulted in capsule
impaction on a stenotic lesion in the small bowel, necessitating surgical removal of the capsule.
Indications for capsule endoscopy can be broken down into those with
bleeding and those with inflammation or mass. It is in the later patient
group, whose pathology has potential for obstruction, that caution should
be advised. Prior to performing capsule endoscopy, patients should
undergo small bowel follow through or CT enterography, in addition to
endoscopy as the authors have suggested. Even in the absence of
clinical obstruction, a stenotic lesion in the small bowel can lead to
capsule impaction and lead to small bowel obstruction. This is especially
important as the authors are involved in drafting guidelines for the
British Society of Gastroenterology on capsule endoscopy and enteroscopy.
Both physicians and patients must understand that there is a small risk of
obstruction from the capsule, even without prior clinical or radiological
evidence. The small risk of surgical intervention should also be
discussed with patients prior to undergoing this novel technique.
Fellow in Colon and
David J. Hochman
Fellow in Colon and
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
1. Sidhu R, Sanders DS, McAlindon ME. Gastrointestinal capsule endoscopy:
from tertiary centres to primary care. BMJ 2006;332:528-31.
Competing interests: No competing interests