Capsule endoscopy (CE) is a major breakthrough technology in the field of gastrointestinal
(GI) endoscopy. It was introduced to the world in the year 2000. Since then, it has
been used all over the world and well established, primarily in the evaluation of
obscure GI bleeding. Over the years, there have been several advancements in the technology
of CE. To begin with, there was only one CE system developed by given imaging system.
Currently, we have several new generation CE systems, which are commercially available
for evaluation of not only small bowel but colon and esophagus as well. The workstation
has also been improvised. However, the major limitations of CE, such as nontherapeutic
capability, are still there. To overcome this challenge, device-assisted enteroscopes
(DAE) have been developed. So now, CE and DAE complement each other, and small bowel
evaluation is no more a dark tunnel.
In India, we started using CE, the moment it was introduced to the world. Since then,
it is widely available all over the country. There are several publications on CE
from India. However, the high cost of procedure continues to be a deterrent in our
country. In the current issue, Chauhan et al.[1] have published their experience of CE, using Micro Cam Capsule endoscope (Intromedic,
Seoul, South Korea), in 102 patients from February 2014 to March 2018. The main indication
of the procedure was obscure GI bleeding. The overall positive diagnostic yield of
CE was 72.5%. The commonly detected lesions were vascular malformations in 20.5%,
nonsteroidal anti-inflammatory drug-induced lesions in 12.7% and small bowel ulcers
in 26.4%. Worm infestation was detected in 3.9% along with other miscellaneous causes.
CE retention occurred in two patients, which required surgical removal. The results
of this study are in concurrence with that of other studies published earlier from
different centers. The highlight of this study is the use of Micro Cam CE system,
which the authors have used in 108 patients, whereas, the majority of other studies
were performed using Given Imaging CE. This is the first study of CE from India, where
Micro Cam CE system has been used in a large cohort of patients. Although there is
no head to head comparison, yet there is no difference in the diagnostic yield and
safety of two different CE systems. This study reemphasizes the utility of CE in the
evaluation of small bowel diseases in general, obscure GI bleeding in particular.
CE is an integral part of GI endoscopy in India. Where do we go from here? Let's see
from the Indian perspective. The cost of the procedure is still a major challenge.
Can we develop an indigenous CE system, which is less expensive than the currently
available CE systems? This is feasible, provided technology industry and health-care
professionals work together. Another challenge is reading time of CE without compromising
the quality of the report. Artificial intelligence technology-based solutions may
be applied to mitigate this challenge. The development of therapeutic capsule endoscope
is a work in progress. India is a major technology hub and may contribute a lot in
developing and designing new generation CE system. So far, CE is an important diagnostic
modality in the evaluation of obscure GI bleeding. It helps not only in the diagnosis
of obscure GI bleeding, but also it acts as a guide to device-assisted enteroscopy
for further therapy. The cost of CE still continues to be a limiting factor in India.
However, the optimum use of CE with or without DAE is not only a cost-effective but
efficacious strategy in evaluation and therapy of small bowel diseases.
The journey of CE in India is progressing at a steady pace.
