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  • Review Article
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Capsule endoscopy: progress update and challenges ahead

Nature Reviews Gastroenterology & Hepatology volume 6, pages 353–361 (2009)Cite this article

Abstract

Capsule endoscopy (CE) enables remote diagnostic inspection of the gastrointestinal tract without sedation and with minimal discomfort. Initially intended for small-bowel endoscopy, modifications to the original capsule have since been introduced for imaging of the esophagus and the colon. This Review presents a research update on CE. Emphasis is placed on PillCam™ SB, PillCam™ ESO, and PillCam™ COLON (Given Imaging, Yoqneam, Israel) since the majority of published studies have investigated these devices. Discussion of initial reports on competing devices, such as EndoCapsule™ (Olympus, Tokyo, Japan) and MiroCam™ (IntroMedic Co., Seoul, Republic of Korea) are also included. The last section of this Review outlines ongoing research and development directed at the identification of capsule location, control of capsule movement and expansion of the capability of microcameras to enhance the diagnostic power of CE. Research efforts aimed at endowing the capsule with a range of functionalities are also discussed, from tissue sampling for biopsy to optical biopsy and, in some cases, actual treatment (interventional CE), so that CE may ultimately replace both diagnostic and interventional flexible endoscopy.

Key Points

  • Capsule endoscopy (CE) has become the 'gold standard' investigation for patients with obscure gastrointestinal bleeding and iron-deficiency anemia

  • CE has the potential to provide early detection of small-bowel tumors, which at present typically present at an advanced stage

  • Diagnostic yield of CE for esophageal metaplasia has not been evaluated in large studies, but CE proved promising for detection and grading of esophageal varices in patients with portal hypertension

  • 'String capsules', which may allow improved imaging of the gastro–esophageal junction, should increase safety against device retention in patients with dysphagia and strictures, as the capsule can be retrieved

  • Colonic CE seems complementary to flexible colonoscopy and is indicated when conventional colonoscopy supplies inconclusive results, is contraindicated, or refused by the patient

  • Future technical advances may lead to the introduction of three categories of capsules: implantable for long-term screening, diagnostic for symptomatic patients, and interventional for delivery of therapy

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Figure 1: Algorithm for the use of capsule endoscopy to investigate occult, obscure gastrointestinal bleeding.
Figure 2: Salient features of the small-bowel capsule endoscopy devices PillCam™ SB, PillCam™ SB2 (Given Imaging, Yoqneam, Israel), EndoCapsule™ (Olympus, Tokyo, Japan) and MiroCam™ (IntroMedic Co. Seoul, Republic of Korea).
Figure 3: PillCam™ ESO (Given Imaging, Yoqneam, Israel).

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Authors and Affiliations

  1. Center for Computer Assisted Surgery, University of Pisa, Pisa, Italy

    Andrea Moglia

  2. Scuola Sant'Anna, Pisa, Italy

    Arianna Menciassi, Paolo Dario & Alfred Cuschieri

  3. The Institute for Medical Science and Technology, University of Dundee, Scotland, UK

    Alfred Cuschieri

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Correspondence to Andrea Moglia.

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Moglia, A., Menciassi, A., Dario, P. et al. Capsule endoscopy: progress update and challenges ahead. Nat Rev Gastroenterol Hepatol 6, 353–361 (2009). https://doi.org/10.1038/nrgastro.2009.69

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