Endoscopy 2023; 55(01): 58-95
DOI: 10.1055/a-1973-3796
Guideline

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

 1   University Division of Gastroenterology, City of Health and Science University Hospital, University of Turin, Turin, Italy
,
 2   Gastroenterology Unit, Valduce Hospital, Como, Italy
,
Edward J. Despott
 3   Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, London, UK
,
Xavier Dray
 4   Sorbonne University, Endoscopy Unit, AP-HP, Hôpital Saint-Antoine, Paris, France
,
Martin Keuchel
 5   Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany
,
Tom Moreels
 6   Division of Gastroenterology and Hepatology, University Hospital Saint-Luc, Brussels, Belgium
,
David S. Sanders
 7   Sheffield Teaching Hospitals NHS Foundation Trust, Gastroenterology Sheffield, Sheffield, UK
,
Cristiano Spada
 8   Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
 9   Università Cattolica del Sacro Cuore, Rome, Italy
,
Cristina Carretero
10   Department of Gastroenterology. University of Navarre Clinic, Healthcare Research Institute of Navarre, Pamplona, Spain
,
11   Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
,
12   Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
,
13   IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna, Bologna, Italy
,
Begona Gonzalez Suarez
14   Gastroenterology Department – ICMDiM, Hospital Clínic of Barcelona, DIBAPS, CiBERHED, Barcelona, Spain
,
15   Centre for Clinical Implementation of Capsule Endoscopy, Store Adenomer Tidlige Cancere Center, Svendborg, University of Southern Denmark, Denmark
,
16   2nd Department of Internal Medicine – Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
17   Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
18   Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
,
Deirdre McNamara
19   TAGG Research Centre, Department of Clinical Medicine, Trinity Centre, Tallaght Hospital, Dublin, Ireland
,
20   Department of Medicine I, University Medical Center Mainz, Mainz, Germany
,
Enrique Perez-Cuadrado-Martinez
21   Sección de Aparato Digestivo, Area VI, Hospital Morales Meseguer, Murcia, Spain
,
22   Department of Gastroenterology, Georges-Pompidou European Hospital, Paris, France
,
Stefania Piccirelli
 8   Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
,
Bruno Rosa
23   Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
24   Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal
25   ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
,
Jean-Christophe Saurin
26   Gastroenterology and Endoscopy Unit, Hospices Civils de Lyon, Hôpital E. Herriot, Lyon, France
,
Reena Sidhu
27   Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
28   Department of Infection, Immunity and Cardiovascular Diseases, University of Sheffield, United Kingdom
,
29   2nd Department of Internal Medicine – Gastroenterology, University Hospital Hradec Králové, Charles University, Faculty of Medicine in Hradec Králové, Czech Republic
,
Erasmia Vlachou
30   Army Share Fund Hospital (NIMTS), Athens, Greece
,
31   Hepatogastroenterology Unit, Second Department of Internal Medicine – Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
› Author Affiliations
 

Main Recommendations

MR1 ESGE recommends small-bowel capsule endoscopy as the first-line examination, before consideration of other endoscopic and radiological diagnostic tests for suspected small-bowel bleeding, given the excellent safety profile of capsule endoscopy, its patient tolerability, and its potential to visualize the entire small-bowel mucosa.
Strong recommendation, moderate quality evidence.

MR2 ESGE recommends small-bowel capsule endoscopy in patients with overt suspected small-bowel bleeding as soon as possible after the bleeding episode, ideally within 48 hours, to maximize the diagnostic and subsequent therapeutic yield.
Strong recommendation, high quality evidence.

MR3 ESGE does not recommend routine second-look endoscopy prior to small-bowel capsule endoscopy in patients with suspected small-bowel bleeding or iron-deficiency anemia.
Strong recommendation, low quality evidence.

MR4 ESGE recommends conservative management in those patients with suspected small-bowel bleeding and high quality negative small-bowel capsule endoscopy.
Strong recommendation, moderate quality evidence.

MR5 ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by small-bowel capsule endoscopy.
Strong recommendation, high quality evidence.

MR6 ESGE recommends the performance of small-bowel capsule endoscopy as a first-line examination in patients with iron-deficiency anemia when small bowel evaluation is indicated.
Strong recommendation, high quality evidence.

MR7 ESGE recommends small-bowel capsule endoscopy in patients with suspected Crohn’s disease and negative ileocolonoscopy findings as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known bowel stenosis.
Strong recommendation, high quality evidence.

MR8 ESGE recommends, in patients with unremarkable or nondiagnostic findings from dedicated small-bowel cross-sectional imaging, small-bowel capsule endoscopy as a subsequent investigation if deemed likely to influence patient management.
Strong recommendation, low quality evidence.

MR9 ESGE recommends, in patients with established Crohn’s disease, the use of a patency capsule before small-bowel capsule endoscopy to decrease the capsule retention rate.
Strong recommendation, moderate quality evidence.

MR10 ESGE recommends device-assisted enteroscopy (DAE) as an alternative to surgery for foreign bodies retained in the small bowel requiring retrieval in patients without acute intestinal obstruction.
Strong recommendation, moderate quality evidence.

MR11 ESGE recommends DAE-endoscopic retrograde cholangiopancreatography (DAE-ERCP) as a first-line endoscopic approach to treat pancreaticobiliary diseases in patients with surgically altered anatomy (except for Billroth II patients).
Strong recommendation, moderate quality evidence.

Supplementary material



Publication History

Article published online:
24 November 2022

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