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

Marco Pennazio; Cristiano Spada; Rami Eliakim; Martin Keuchel; Andrea May; Chris J. Mulder; Emanuele Rondonotti; Samuel N. Adler; Joerg Albert; Peter Baltes; Federico Barbaro; Christophe Cellier; Jean Pierre Charton; Michel Delvaux; Edward J. Despott; Dirk Domagk; Amir Klein; Mark McAlindon; Bruno Rosa; Georgina Rowse; David S. Sanders; Jean Christophe Saurin; Reena Sidhu; Jean-Marc Dumonceau; Cesare Hassan; Ian M. Gralnek

doi:10.1055/s-0034-1391855

Endoscopy, Table of Contents

Endoscopy 2015; 47(04): 352-386
DOI: 10.1055/s-0034-1391855

Guideline

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

Marco Pennazio

¹Division of Gastroenterology, San Giovanni Battista University Teaching Hospital, Turin, Italy

,

Cristiano Spada

²Digestive Endoscopy Unit, Catholic University, Rome, Italy

,

Rami Eliakim

³Department of Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University Tel-Hashomer, Israel

,

Martin Keuchel

⁴Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Hamburg, Germany

,

Andrea May

⁵Department of Medicine II, Sana Klinikum, Offenbach, Germany

,

Chris J. Mulder

⁶Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands

,

Emanuele Rondonotti

⁷Gastroenterology Unit, Ospedale Valduce, Como, Italy

,

Samuel N. Adler

⁸Division of Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel

,

Joerg Albert

⁹Department of Medicine I, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany

,

Peter Baltes

⁴Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Hamburg, Germany

,

Federico Barbaro

²Digestive Endoscopy Unit, Catholic University, Rome, Italy

,

Christophe Cellier

¹⁰Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service d'Hépato-gastro-entérologie, Paris, France

,

Jean Pierre Charton

¹¹Medizinische Klinik, Evangelisches Krankenhaus, Düsseldorf, Germany

,

Michel Delvaux

¹²Department of Hepato-Gastroenterology, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France

,

Edward J. Despott

¹³Royal Free Unit for Endoscopy and Centre for Gastroenterology, The Royal Free Hospital and University College London, London, UK

,

Dirk Domagk

¹⁴Department of Medicine B, University of Münster, Münster, Germany

,

Amir Klein

¹⁵Institute of Gastroenterology and Liver Diseases, Ha’emek Medical Center Afula, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology Haifa, Israel

,

Mark McAlindon

¹⁶Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

,

Bruno Rosa

¹⁷Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal.

,

Georgina Rowse

¹⁸Clinical Psychology Unit, Department of Psychology, University of Sheffield.

,

David S. Sanders

¹⁶Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

,

Jean Christophe Saurin

¹⁹Centre Hospitalier Lyon Sud, Pierre Bénite, Lyon, France

,

Reena Sidhu

¹⁶Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

,

Jean-Marc Dumonceau

²⁰Gedyt Endoscopy Center, Buenos Aires, Argentina

,

Cesare Hassan

²Digestive Endoscopy Unit, Catholic University, Rome, Italy

²¹Department of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy

,

Ian M. Gralnek

¹⁵Institute of Gastroenterology and Liver Diseases, Ha’emek Medical Center Afula, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology Haifa, Israel

› Author Affiliations

Abstract

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Guideline was also reviewed and endorsed by the British Society of Gastroenterology (BSG). It addresses the roles of small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders.

Main recommendations

1 ESGE recommends small-bowel video capsule endoscopy as the first-line investigation in patients with obscure gastrointestinal bleeding (strong recommendation, moderate quality evidence).

2 In patients with overt obscure gastrointestinal bleeding, ESGE recommends performing small-bowel capsule endoscopy as soon as possible after the bleeding episode, optimally within 14 days, in order to maximize the diagnostic yield (strong recommendation, moderate quality evidence).

3 ESGE does not recommend the routine performance of second-look endoscopy prior to small-bowel capsule endoscopy; however whether to perform second-look endoscopy before capsule endoscopy in patients with obscure gastrointestinal bleeding or iron-deficiency anaemia should be decided on a case-by-case basis (strong recommendation, low quality evidence).

4 In patients with positive findings at small-bowel capsule endoscopy, ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by capsule endoscopy (strong recommendation, high quality evidence).

5 ESGE recommends ileocolonoscopy as the first endoscopic examination for investigating patients with suspected Crohn’s disease (strong recommendation, high quality evidence).

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

ESGE does not recommend routine small-bowel imaging or the use of the PillCam patency capsule prior to capsule endoscopy in these patients (strong recommendation, low quality evidence).

In the presence of obstructive symptoms or known stenosis, ESGE recommends that dedicated small bowel cross-sectional imaging modalities such as magnetic resonance enterography/enteroclysis or computed tomography enterography/enteroclysis should be used first (strong recommendation, low quality evidence).

6 In patients with established Crohn’s disease, based on ileocolonoscopy findings, ESGE recommends dedicated cross-sectional imaging for small-bowel evaluation since this has the potential to assess extent and location of any Crohn’s disease lesions, to identify strictures, and to assess for extraluminal disease (strong recommendation, low quality evidence).

In patients with unremarkable or nondiagnostic findings from such cross-sectional imaging of the small bowel, ESGE recommends small-bowel capsule endoscopy as a subsequent investigation, if deemed to influence patient management (strong recommendation, low quality evidence).

When capsule endoscopy is indicated, ESGE recommends use of the PillCam patency capsule to confirm functional patency of the small bowel (strong recommendation, low quality evidence).

7 ESGE strongly recommends against the use of small-bowel capsule endoscopy for suspected coeliac disease but suggests that capsule endoscopy could be used in patients unwilling or unable to undergo conventional endoscopy (strong recommendation, low quality evidence).

Full Text

References

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