Literature review and recommendations for clinical application of small-bowel capsule endoscopy, based on a panel discussion by international experts

Background and methods

This review is based on two meetings sponsored by Given Imaging as part of their annual International Conference on Capsule Endoscopy (ICCE), a meeting which was held in two parts, one in Miami in March 2006 and the second in Paris in June 2006.

In order to arrive at a consensus on small-bowel endoscopy indications, results, and outcome data, between five and seven experts, selected by chairmen for each of the subtopics, were asked to review and modify consensus statements in six different areas: intestinal preparations and prokinetics (both considered by a single group), obscure gastrointestinal bleeding, small-bowel tumors, inflammatory bowel disease, and celiac disease. In each of the five groups, two people prepared key questions and answers to relevant questions in their area, as well as preparing literature that was sent in advance to the other participants. These issues were then discussed within the groups and the final statements were drafted. The manuscript based on these statements was then sent to the group members for comments and modifications. Necessarily, only one aspect of performance, such as preparatory measures, was considered, and others (especially complications and risks) were not dealt with in this meeting.

For the evidence cited in this publication as a basis for group decision making, only original articles in peer-reviewed journals and, if deemed appropriate, abstracts from the two major gastroenterology congresses (Digestive Diseases Week [DDW], United European Gastroenterology Week [UEGW]) of the last two years were used. Evidence from important original research published up till summer 2007 was added during manuscript preparation, even after the meeting, to keep the consensus up to date especially when additional evidence was considered practically relevant.

A general methodological problem in studies on capsule endoscopy is the absence of a reliable gold standard; terms used in clinical research for many years, such as sensitivity, specificity, predictive values etc., have therefore been replaced by the surrogate parameter ”yield,“ with evident inherent limitations. With the advent of double-balloon enteroscopy (DBE), it may be possible to provide a more reliable gold standard, but systematic data are lacking, since case series on DBE use a similar methodology and the entire small bowel is examined in only a small minority of cases included in these studies.

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