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Capsule endoscopy : recent developments
  1. Jean Paul Galmiche (jeanpaul.galmiche{at}chu-nantes.fr)
  1. CHU Nantes University Hospital, France
    1. Emmanuel Coron (emmanuel.coron{at}chu-nantes.fr)
    1. CHU Nantes University Hospital, France
      1. Sylvie Sacher-Huvelin (sylvie.sacherhuvelin{at}chu-nantes.fr)
      1. CHU Nantes University Hospital, France

        Abstract

        Wireless capsule endoscopy (WCE) is a new technology which has been developed for investigation of the small bowel. Until recently, the small bowel was an organ which was difficult to explore, being largely blind to conventional endoscopic investigation. In routine practice only the last few centimetres of the ileum are accessible to retrograde exploration by ileocolonoscopy (IC). Investigation from the proximal side by push enteroscopy is a somewhat invasive procedure which usually does not allow the investigation of more than 60 cm of proximal jejunum. Small bowel WCE, therefore, represents a major advance; it is a safe, non invasive procedure and many studies have established beyond doubt that it is cost-effective in a variety of clinical situations, including bleeding of obscure origin, detection of small bowel lesions in inflammatory bowel disease (IBD), NSAIDs enteropathies, and tumours. The context of using WCE to investigate the upper (oesophagus, stomach and duodenum) and lower (rectum and colon) GI segments is completely different. All of these areas of the gut are easily accessible to conventional endoscopy, either by oesogastroduodenoscopy (OGD) or IC. These procedures are routinely performed by the majority of gastroenterologists; they allow biopsy sampling (which is not possible with WCE) and eventually therapeutic interventions such as polypectomy or mucosectomy. However, despite its merits, conventional endoscopy also has some limitations, which will be discussed specifically in this article in relation to the investigation of the upper and lower GI tract. Conventional endoscopy is also a relatively invasive procedure with high costs, especially when performed under sedation or general anaesthesia. Recently, novel developments in WCE technology have made possible the investigation of both the proximal and distal segments of the gut using specifically-designed devices. The aim of this article is to review the published literature regarding these novel capsule endoscopic tools. Because information is frequently available only in abstract form we have tried to obtain the most updated data from authors and/or from the company (Given Imaging, Ltd) that produces these devices. To our knowledge, no oesophageal or colon evaluation has been made to date with endoscopic capsules developed by other companies that produce small bowel devices (e.g. Olympus, Ltd). Emphasis has been placed on information available from full articles published in peer-reviewed journals. It is out of the scope of this review to discuss recent developments in small bowel capsule endoscopy and the reader is referred to recent literature on this topic.1

        • barrett's oesophagus
        • capsule endoscopy
        • colonic neoplasia
        • portal hypertension

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