GI Blog

Tips on Small Bowel Capsule Endoscopy and Its Application in Clinical Practice

20 January 2023

1. The method of small bowel capsule endoscopy

Small bowel capsule endoscopy (SBCE) is the test of choice for suspected small bowel bleeding, but it is also helpful for Crohn's disease, refractory celiac disease, and small bowel tumors. Small bowel capsule endoscopy (SBCE) is technically demanding, and its quality depends on preoperative bowel preparation, intraoperative SBCE image collection and postoperative reporting, and assessment of capsule expulsion. These may also reflect the wide variation in SBCE practices across regions and organizations.

To address this issue, the European Society for Gastrointestinal Endoscopy (ESGE) has published clinical and technical evidence-based guidelines outlining a series of basic recommendations to be followed to improve the quality of small bowel capsule endoscopy (SBCE). Despite these guidelines, it is unclear whether they have been incorporated into clinical practice.

In this regard, the current study aimed to document routine practices during SBCE endoscopy, both in ESGE countries and in those not covered by ESGE (hereafter referred to as "ESGE countries" and "non-ESGE countries", respectively) , and investigate the potential impact of small bowel capsule endoscopy (SBCE) guidelines on practice.

2. Guidelines for small bowel capsule endoscopy

In a web-based small bowel capsule endoscopy survey, participants contacted through the ESGE contact list completed 52 options. Of these, 217 countries (176 and 41, respectively, from national associations that are or are not part of ESGE) responded. Of the respondents, 45% received formal SBCE training.

In small bowel capsule endoscopy (SBCE), 91% of patients had ESGE-recommended indications, with occult gastrointestinal bleeding (OGIB), iron deficiency anemia (IDA), and suspected/confirmed Crohn's disease being the most common Yes, the positive diagnosis rate was higher (49.4%, 38.2% and 53.5%, respectively).

When SBCE was negative for OGIB or IDA, 46.7% and 70.3% preferred regular follow-up. For 62.2% of respondents, SBCE was the second-line test to assess the severity of new-onset Crohn's disease.

Small bowel capsule endoscopists adhered to varying degrees with ESGE technical recommendations regarding bowel preparation (>60%), use in patients with pacemakers (62.5%), use of laxatives (51.2%), and use of Validated bowel preparation assessment scale (13.3%). Of the respondents, 67% interpret the SBCE test themselves, and 84% categorize the test results as either relevant or irrelevant. Two-thirds expect SBCE demand to increase in the future. The inability to obtain pathological tissue (78.3%) and the high cost (68.1%) were considered to be the main limiting factors for SBCE. In addition, artificial intelligence was considered to be the most important development direction (56.2%).

Therefore, small bowel capsule endoscopists follow ESGE guidelines on the clinical use of SBCE to some extent. However, discrepancies still exist in real practice, the impact of which needs to be further assessed.