Future directions of capsule endoscopy

Abstract

The availability of wireless capsule endoscopy (CE) in 2001 has completely revolutionized the approach to patients with small bowel disease, particularly those with small bowel bleeding. Capsule endoscopy is now recommended by many international guidelines as the first-line investigation of obscure GIB after negative upper and lower GI endoscopy. Previous studies have demonstrated the superiority of CE over conventional small bowel investigations such as Barium studies, angiography and CT scan. Apart from SB bleeding, CE is also useful for the assessment of unexplained iron deficiency anemia and surveillance of SB polyps in patients with polyposis syndrome. CE can also apply to the assessment of small bowel mucosal healing in patients with Crohn's disease but there is a considerable risk of capsule retention with that indication. As yet, current capsule endoscopy systems are all propelled passively by peristalsis and cannot be manipulated once swallowed. Whereas self-propelled CE is still largely under animal or ex-vivo investigations, an external magnetic device has been shown to be able to control the capsule endoscope for complete examination of the stomach. The sensitivity for gastric lesions detection was up to 90% when compared to conventional gastroscopy and may serve as an alternative for gastroscopy. The SmartPill is another ingestible capsule device which is intended for the measurement of intestinal pressure, pH and temperature in the gastrointestinal tract for motility assessment. However, the current device lacks video function and the incorporation of video recording facilities may provide an even more comprehensive evaluation of the human gastrointestinal tract. Future research innovations are also needed to evaluate the potential of capsule endoscopy on therapeutic targeting of the intestinal tract.