Enteroscopy and capsule endoscopy

Introduction

Research interest in small-bowel endoscopy continues to be strong, even though 5 years have now passed since the advent of capsule endoscopy (CE), followed by that of double-balloon endoscopy (DBE), causing a revolution in this sector of endoscopy. Fully 120 scientific contributions on the subject were presented at Digestive Disease Week (DDW) this year, 83 of which concerned CE, 27 DBE, with 10 being comparisons between the two techniques (Figure [1]). This review discusses in detail the 20 most significant of these. Numerous studies have analyzed technical aspects of CE and the wide therapeutic applications of DBE, often in series that were insufficiently large, heterogeneous, and mainly with retrospective analysis. Gastrointestinal bleeding is still the field in which the two methods are most often clinically applied, and that in which the scientific evidence is most solid. For some indications for CE, such as inflammatory bowel diseases and esophageal disorders, there is still controversy regarding its real clinical usefulness. Most comparative studies hold that CE is a valuable screening test, while DBE should serve as the confirmatory/therapeutic modality (Figure [2]).

Figure 1 Number of abstracts devoted to capsule endoscopy (CE) and to double-balloon endoscopy (DBE) at DDW 2006.

Figure 2 a Capsule endoscopy (CE): a large angiectasia in the mid-ileum of a patient with obscure-overt bleeding. b Double-balloon endoscopy: the same patient, showing the lesion previously identified by CE. c Double-balloon endoscopy: ileal angiectasia after argon plasma cauterization.

References

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• 3 Chung H, Ali J, Dhaliwhal H. et al . Capsule endoscopy: benefit in evaluation of “missed” endoscopic lesions in obscure GI bleeding [abstract].  Gastrointest Endosc. 2006;  63 AB151
• 4 Saperas E, Dot J, Videla S. et al . A prospective comparison of capsule endoscopy, helical CT angiography and mesenteric angiography for the diagnosis of obscure gastrointestinal bleeding (OGIB) [abstract].  Gastrointest Endosc. 2006;  63 AB92
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• 7 Dhaliwal H, Shapira S, Chung H. et al . Repeated capsule endoscopy: is there a benefit? [abstract].  Gastrointest Endosc. 2006;  63 AB148
• 8 Kimble J S, Wong R C, Chak A. et al . Variation in diagnostic yield of back-to-back capsule endoscopy in obscure GI bleeding: preliminary results [abstract].  Gastrointest Endosc. 2006;  63 AB91
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• 29 Mitsui K, Tanaka S, Ehara A. et al . Impact of double-balloon endoscopy on clinical management of obscure gastrointestinal bleeding [abstract].  Gastroenterology. 2006;  130 A37
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• 31 Riccioni M E, Shah S, Bizzotto A. et al . Capsule endoscopy findings and clinical outcome in patients with obscure gastrointestinal bleeding [abstract].  Gastrointest Endosc. 2006;  63 AB115
• 32 Ross A, Mehdizadeh S, Tokar J. et al . Double-balloon enteroscopy for the detection of small bowel mass lesions presenting as obscure gastrointestinal bleeding: do we have a new gold standard? [abstract].  Gastrointest Endosc. 2006;  63 AB159
• 33 Suzuki T, Matsushima M, Shirai T. et al . Clinical significance of double-balloon enteroscopy for small intestinal bleeding [abstract].  Gastrointest Endosc. 2006;  63 AB180
• 34 Tuyl S V, Letteboer T GW, Rogge-Wolf C. et al . Assessment of intestinal vascular malformations in patients with hereditary hemorrhagic telangiectasia and anemia [abstract].  Gastrointest Endosc. 2006;  63 AB159
• 35 Urbain D, De Looze D, Hindryckx P. et al . Video capsule endoscopy findings in cirrhosis with portal hypertension: a prospective study [abstract].  Gastroenterology. 2006;  130 A478
• 36 Walsh A, Appleyard M N. Capsule endoscopy for obscure gastrointestinal bleeding: a report of 100 consecutive cases to investigate long term clinical outcomes [abstract].  Gastrointest Endosc. 2006;  63 AB154
• 37 Arakawa D, Ohmiya N, Nakamura M. et al . Usefulness of double-balloon enteroscopy (DBE) for diagnosis and treatment of obscure gastrointestinal bleeding in comparison with capsule endoscopy (CE) [abstract].  Gastrointest Endosc. 2006;  63 AB175
• 38 Damian U, Schilling D, Hartmann D. et al . Double-balloon enteroscopy (push and pull enteroscopy) of the small bowel: comparison with video capsule endoscopy and magnetic resonance imaging [abstract].  Gastrointest Endosc. 2006;  63 AB174
• 39 Gonzalez-Suarez B, Galter S, Espinos J. et al . Comparative study of capsule endoscopy, mesenteric angiography and double-balloon enteroscopy in obscure gastrointestinal bleeding: preliminary results [abstract].  Gastroenterology. 2006;  130 A476
• 40 Jang H, Choi M, Park C. et al . Comparison of double-balloon enteroscopy and capsule endoscopy in patients with suspected small bowel diseases [abstract].  Gastrointest Endosc. 2006;  63 AB181
• 41 Hirata M, Imase K, Yamada Y. et al . Study on japanese patients with obscure gastrointestinal bleeding based on the combined use of capsule endoscopy and double-balloon endoscopy [abstract].  Gastrointest Endosc. 2006;  63 AB182
• 42 Maniere T, Landi B, Simon M. et al . Double-balloon enteroscopy had superior diagnostic and therapeutic impact than push enteroscopy for the diagnosis and the treatment of lesions identified by videocapsule endoscopy [abstract].  Gastroenterology. 2006;  130 A324
• 43 Wi J, Kim J, Eun S. et al . A prospective comparison of capsule endoscopy and double-balloon enteroscopy in small bowel disease [abstract].  Gastrointest Endosc. 2006;  63 AB175
• 44 Araki A, Tsuchiya K, Oshima S. et al . Double-balloon enteroscopy: first one year experience and modified technique (double-over tube method) [abstract].  Gastrointest Endosc. 2006;  63 AB186
• 45 Byeon J, Choi K, Yang S. et al . Comparison of double-balloon enteroscopy and small bowel series in the evaluation of small bowel lesion [abstract].  Gastrointest Endosc. 2006;  63 AB172
• 46 Chen G, Goltzer O, Shen J. et al . A novel external lead sensor array placement approach for capsule endoscopy [abstract].  Gastrointest Endosc. 2006;  63 AB245
• 47 Cho Y, Kim C, Keum B. et al . Can the small-bowel transit time influence the diagnostic yields of capsule endoscopy? [abstract].  Gastrointest Endosc. 2006;  63 AB158
• 48 Gaddipati K, Parkman H, Krevsky B. A novel method for the assessment of gastric motility in patients using wireless capsule endoscopy [abstract].  Gastroenterology. 2006;  130 A437
• 49 Ge Z, Chen H, Gao Y. et al . Clinical application of wireless capsule endoscopy in pediatric and adolescent patients [abstract].  Gastrointest Endosc. 2006;  63 AB185
• 50 Hernandez O V, Blancas-Valencia M J, Paz-Flores V M. et al . Double balloon enteroscopy in the diagnosis of small bowel diseases: the Mexican experience [abstract].  Gastrointest Endosc. 2006;  63 AB180
• 51 Holden J P, Dureja P, Pfau P. et al . Endoscopic placement of the Given™ PillCam small bowel video capsule using the advanCE™ capsule endoscope delivery device: a retrospective case series [abstract].  Gastrointest Endosc. 2006;  63 AB188
• 52 Jalal P K, Devito B, Greenberg R. et al . Gastric retention is common with in-patient wireless capsule endoscopy [abstract].  Gastrointest Endosc. 2006;  63 AB178
• 53 Keuchel M, Csomos G, Al-Harthi S. et al . Endoscopic placement of the video capsule with the advanCE™ delivery device [abstract].  Gastrointest Endosc. 2006;  63 AB185
• 54 Kim Y, Jeen Y, Kong H. et al . Is the present power of capsule endoscopy strong enough? Its ability to detect normally positioned duodenal papilla [abstract].  Gastrointest Endosc. 2006;  63 AB147
• 55 Kita H, Yamamoto H, Yano T. et al . Over four hundred experiences of double-balloon endoscopy for small intestinal disorders [abstract].  Gastrointest Endosc. 2006;  63 AB174
• 56 Kucera S, Abbass R, Isenberg G. et al . Association of regional transit abnormalities identified on capsule endoscopy with underlying pathology [abstract].  Gastrointest Endosc. 2006;  63 AB168
• 57 Kuga R, Safatle-Ribeiro A V, Sakai P. et al . Usefulness of the double-balloon enteroscope for endoscopic evaluation of the bypassed stomach after vertical banded gastroplasty with Roux-en-Y gastric bypass for morbid obesity [abstract].  Gastrointest Endosc. 2006;  63 AB162
• 58 Law N. Single-operator double balloon enteroscopy in the management of small bowel diseases [abstract].  Gastrointest Endosc. 2006;  63 AB164
• 59 Lee H, Condon D, Mineyama Y. et al . Effect of erythromycin on transit time in video capsule endoscopy: a randomized prospective placebo controlled trial [abstract].  Gastrointest Endosc. 2006;  63 AB159
• 60 Maaser C, Ullerich H, Menzel K. et al . Double balloon enteroscopy - a useful diagnostic tool? Analysis of a large, non-selected cohort of patients regarding success and complications of double balloon endoscopy [abstract].  Gastroenterology. 2006;  130 A476
• 61 Mishkin D S, Lucey B C. Early experience with CT enterography (CTE) in patients before video capsule endoscopy (VCE) [abstract].  Gastrointest Endosc. 2006;  63 AB168
• 62 Mitsui K, Tanaka S, Ehara A. et al . Double-balloon endoscopy for small intestinal diseases: experience of 200 consecutive examinations [abstract].  Gastrointest Endosc. 2006;  63 AB164
• 63 Moenkemueller K, Kolfenbach S, Fry L C. et al . Diagnostic, clinical and therapeutic impact of double-balloon enteroscopy [abstract].  Gastrointest Endosc. 2006;  63 AB238
• 64 Moy L, Levine J. The role of capsule endoscopy in the evaluation of patients with unexplained growth failure [abstract].  Gastroenterology. 2006;  130 A190
• 65 Muhammad A, Akula Y, Pitchumoni C. Role of wireless capsule endoscopy (WCE) in geriatric gastroenterology [abstract].  Gastroenterology. 2006;  130 A477
• 66 Nakamura M, Niwa Y, Ohmiya N. et al . Accuracy of localization of small bowel disorder detected by capsule endoscopy [abstract].  Gastrointest Endosc. 2006;  63 AB167
• 67 Ngo K, Gendy E, Klooster M. et al . Wireless capsule endoscopy (WCE) in pediatric gastroenterology practice [abstract].  Gastrointest Endosc. 2006;  63 AB95
• 68 Oosterveen S, Rahimi R, Losurdo J. et al . Inpatient capsule endoscopy leads to frequent incomplete small bowel examinations [abstract].  Gastrointest Endosc. 2006;  63 AB149
• 69 Ponferrada-Diaz A, Menchen-Viso L, Gonzalez-Asanza C. et al . Evaluation of QuickView system and Suspected Blood Indicator test from of Given M2A plus capsule endoscopy software in the clinical setting [abstract].  Gastrointest Endosc. 2006;  63 AB227
• 70 Pons V, Gonzalez B, Gonzalez C. et al . Evaluation of different bowel preparations for the study with capsule endoscopy: a prospective, randomized, controlled study [abstract].  Gastrointest Endosc. 2006;  63 AB161
• 71 Ross A, Prachand V, Alverdy J. et al . There and back again: new approaches to old problems using double-balloon enteroscopy [abstract].  Gastrointest Endosc. 2006;  63 AB182
• 72 Sanchez-Yague A, Romero-Vazquez J, Caunedo-Alvarez A. et al . Limitations in capsule endoscopy examinations [abstract].  Gastrointest Endosc. 2006;  63 AB114
• 73 Schneider A W, Vogell V, Rost M. et al . Fluoroscopy in double-balloon enteroscopy [abstract].  Gastrointest Endosc. 2006;  63 AB162
• 74 Schnoll-Sussman F H, Bergwerk A, Eliakim R. et al . New capsule endoscopy viewing mode may improve reading efficiency without effect on pathology detection rate [abstract].  Gastrointest Endosc. 2006;  63 AB227
• 75 Seitz U, Dy F, Naga M Y. et al . Influence of experience, scanning speed, and the use of a jog-shuttle device on the detection rate in capsule endoscopy [abstract].  Gastrointest Endosc. 2006;  63 AB108
• 76 Serer C, Serer A R, Beckerman A H. et al . Initial experience with capsule endoscopy in a single specialty community based adult gastroenterology practice [abstract].  Gastrointest Endosc. 2006;  63 AB188
• 77 Shamsa M, Wong R, Fang J. et al . Risk factors for incomplete or unsatisfactory capsule endoscopy [abstract].  Gastrointest Endosc. 2006;  63 AB193
• 78 Storch I M, Schmelkin I, Vance S. et al . A double blind placebo controlled study of tegaserod to increase gastric and small bowel transit times with wireless capsule endoscopy (WCE): preliminary data [abstract].  Gastrointest Endosc. 2006;  63 AB192
• 79 Tanaka S, Mitsui K, Tatsuguchi A. et al . Double-balloon endoscopy for the treatment of small intestinal diseases [abstract].  Gastrointest Endosc. 2006;  63 AB177
• 80 Tanaka S, Mitsui K, Tatsuguchi A. et al . Usefulness of double-balloon endoscopy for diagnosis and treatment of the post-operative gastrointestinal tract [abstract].  Gastrointest Endosc. 2006;  63 AB291
• 81 Tokar J L, Nguyen M, Downey S. et al . Findings and perceived impact of double-balloon enteroscopy in a US population [abstract].  Gastrointest Endosc. 2006;  63 AB181
• 82 Tokar J L, Nguyen M, Downey S. et al . Initial description of technical aspects of double-balloon enteroscopy in a US population [abstract].  Gastrointest Endosc. 2006;  63 AB181
• 83 Toy E K, Rojany M, Mann S. et al . Impact of capsule endoscopy on clinical outcomes [abstract].  Gastrointest Endosc. 2006;  63 AB1323
• 84 Wi J, Moon J, Kim Y. et al . A prospective randomized multicenter study of preparation for capsule endoscopy [abstract].  Gastrointest Endosc. 2006;  63 AB168
• 85 Wijeratne R, Condon D. Ampulla of Vater is infrequently visualized by capsule endoscopy [abstract].  Gastrointest Endosc. 2006;  63 AB172
• 86 Bennato R, Manguso F, D’Arienzo A. et al . A novel diagnostic approach in patients with indeterminate colitis: wireless capsule enteroscopy [abstract].  Gastroenterology. 2006;  130 A477
• 87 Choi H, Choi K, Lee B. et al . Differentiation of small bowel strictures by double-balloon endoscopy [abstract].  Gastrointest Endosc. 2006;  63 AB186
• 88 Erber J A, Erber W F, Sagiv S K. et al . Wireless capsule endoscopy in suspected Crohn’s disease: correlation of findings with IBD serology [abstract].  Gastrointest Endosc. 2006;  63 AB167
• 89 Gal E, Geller A, Frase G. et al . Assessment of a new simple capsule endoscopy Crohn’s disease activity index (CECDAI) [abstract].  Gastroenterology. 2006;  130 A477
• 90 Galter S, Gonzalez B, Monfort D. et al . Usefulness of the capsule endoscopy in the study of the inflammatory bowel disease: preliminary results [abstract].  Gastroenterology. 2006;  130 A478
• 91 Girelli G M, Porta P, Rocca F. Clinical outcome of patients submitted to capsule endoscopy for suspect Crohn’s disease [abstract].  Gastroenterology. 2006;  130 A476
• 92 Law J, Whittaker S, Halparin L. et al . Capsule endoscopy diagnosed small bowel ulceration: is this really Crohn’s disease? [abstract].  Gastrointest Endosc. 2006;  63 AB178
• 93 Maiden L, Seigal A, Bjarnason I. et al . Long-term NSAID use and small bowel pathology: a cross-sectional quantification by capsule enteroscopy [abstract].  Gastroenterology. 2006;  130 A320
• 94 Matsui T, Seki T, Yao K. et al . Usefulness and limitation of double-balloon enteroscopy in inflammatory small bowel disease [abstract].  Gastrointest Endosc. 2006;  63 AB179
• 95 O’Loughlin C J, Slinde N, Kugathasen S. The utility of wireless capsule endoscopy in the evaluation of suspected Crohn’s disease in the pediatric population [abstract].  Gastrointest Endosc. 2006;  63 AB185
• 96 Occhipinti P, Saettone S, Broglia L. et al . M2A patency capsule in small bowel Crohn’s disease [abstract].  Gastrointest Endosc. 2006;  63 AB250
• 97 Poletti P B, Secchi T F, Ying T. et al . Crohn’s disease evolving the small bowel alone: in which symptoms do we need to investigate the small bowel? [abstract].  Gastrointest Endosc. 2006;  63 AB177
• 98 Roorda A K, Gill K S, Mendelson T. et al . Wireless capsule endoscopy in patients with leaky gut syndrome [abstract].  Gastrointest Endosc. 2006;  63 AB172
• 99 Schluender S J, Mehdizadeh S, Vasiliaukas A E. et al . Does preoperative wireless endoscopic capsule predict long-term outcome after ileal pouch-anal anastomosis (IPAA)? [abstract].  Gastroenterology. 2006;  130 A214
• 100 Schoo R, Buening C, Ockenga J. et al . Mucosal healing in the small intestine detected by wireless capsule endoscopy [abstract].  Gastroenterology. 2006;  130 A220
• 101 Matheus T, Anand G, Wadhwa N. et al . Screening for esophageal varices with the PillCam ESO in patients with cirrhosis and massive ascites [abstract].  Gastroenterology. 2006;  130 A478
• 102 Muhammad A, Bhargava S, Pitchumoni C. Capsule endoscopy (PillCam ESO): its utility in diagnosing esophageal varices in patients with chronic liver disease [abstract].  Gastroenterology. 2006;  130 A312
• 103 Plum N, May A, Ipsen A. et al . Prospective evaluation of the esophageal capsule endoscopy for detection of Barrett’s esophagus and early Barrett’s cancer [abstract].  Gastrointest Endosc. 2006;  63 AB144
• 104 Sacher-Huvelin S, Coron E, Ben S oussan. et al . Wireless capsule for esophageal endoscopy: comparison with upper GI conventional endoscopy [abstract].  Gastroenterology. 2006;  130 A476
• 105 Sharma P, Rastogi A, Esquivel R. et al . Accuracy of wireless capsule endoscopy for the detection of Barrett’s esophagus [abstract].  Gastroenterology. 2006;  130 A262
• 106 Spiegel B M, Esrailian E, Eisen G. The budget impact of screening for esophageal varices (EV) with capsule endoscopy [abstract].  Gastrointest Endosc. 2006;  63 AB79
• 107 Stipho S, Tharalson E, Akins R. et al . String capsule endoscopy (SCE) for the screening and surveillance of esophageal varices: a prospective, blinded, comparative study with EGD [abstract].  Gastrointest Endosc. 2006;  63 AB129
• 108 Wolfson D, Barkin J, Friedman S. et al . Delayed esophageal clearance in patients with Barrett’s esophagus as assessed by PillCam ESO™ [abstract].  Gastroenterology. 2006;  130 A170
• 109 Allison E, Kiraly Z, Springer G S. et al . Design, development, and testing of a remote-controlled, stereoscopic (three-dimensional) imaging, self-propelled, wireless capsule endoscope [abstract].  Gastrointest Endosc. 2006;  63 AB104
• 110 Ogata H, Kumai K, Imaeda H. et al . Clinical impact of a newly-developed capsule endoscope: usefulness of a real time image viewer against gastrointestinal transit abnormality [abstract].  Gastrointest Endosc. 2006;  63 AB177
• 111 Rey J F, Kuznetsov K, Vazquez-Ballesteros E. Olympus capsule endoscope for small and large bowel exploration [abstract].  Gastrointest Endosc. 2006;  63 AB176
• 112 Seitz U, Ang T, Bohnacker S. et al . Comparison of image quality of two different capsule endoscopy systems [abstract].  Gastrointest Endosc. 2006;  63 AB225
• 113 Swain P, Mosse S, Ikeda K. et al . Deconstructing the endoscope: intragastric, transgastric and laparoscopic wireless endosurgery using manipulable attached and free capsule imagers [abstract].  Gastrointest Endosc. 2006;  63 AB104
• 114 Atlas D S, Van Dyke C T, Lahr B D. et al . Utility of capsule enteroscopy in symptomatic patients with celiac disease [abstract].  Gastrointest Endosc. 2006;  63 AB178
• 115 Hadithi M, Heine D G, Al Toma A. et al . Endoscopic and histological findings of the small bowel in patients with celiac disease: the additional value of double-balloon endoscopy [abstract].  Gastroenterology. 2006;  130 A664
• 116 Hernandez O V, Blancas M J, Paz V M. et al . Clinical impact of double-balloon enteroscopy in the diagnosis and treatment of malignant small bowel tumors [abstract].  Gastrointest Endosc. 2006;  63 AB179
• 117 Honda W, Ohmiya N, Arakawa D. et al . Diagnosis and treatment of small intestinal tumors/polyps at double-balloon enteroscopy (DBE) and capsule endoscopy (CE) [abstract].  Gastrointest Endosc. 2006;  63 AB167
• 118 Moenkenmueller K, Fry L C, Ebert M. et al . Double-balloon enteroscopy (DBE) assisted chromoendoscopy of the small bowel in patients with familial adenomatous polyposis (FAP) syndrome [abstract].  Gastrointest Endosc. 2006;  63 AB244
• 119 Plum N, May A, Ell C. The diagnostic value of push-enteroscopy, capsule endoscopy, ileoscopy and enteroclysis (Sellink) for small bowel evaluation in patients with familial adenomatous polyposis (FAP): a comparative prospective trial [abstract].  Gastrointest Endosc. 2006;  63 AB180
• 120 Zhang H, Morgan D, Cecil G. et al . Biochromoendoscopy: molecular imaging with capsule endoscopy for detection of polypoid lesions in the GI tract [abstract].  Gastroenterology. 2006;  130 A475