Copyright ©2007 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2007; 13(46): 6140-6149
Published online Dec 14, 2007. doi: 10.3748/wjg.v13.i46.6140
Small bowel capsule endoscopy in 2007: Indications, risks and limitations
Emanuele Rondonotti, Federica Villa, Chris JJ Mulder, Maarten AJM Jacobs, Roberto de Franchis
Emanuele Rondonotti, Federica Villa, Roberto de Franchis, Università degli Studi di Milano, IRCCS Fondazione Policlinico, Mangiagalli, Regina Elena.Unità Operativa di Gastroenterologia 3 via Pace 9, Milano 20122, Italy
Chris JJ Mulder, Maarten AJM Jacobs, VU University Medical Centre, Department of Gastroenterology and Hepatology, Boelelaan 1117, 1081 HV Amsterdam, The Nederlands
Author contributions: All authors contributed equally to the work.
Correspondence to: Emanuele Rondonotti, MD, Universutà degli Studi di Milano, IRCCS Fondazione Policlinico, Mangiagalli, Regina Elena, Unità Operativa di Gastroenterologia 3, Via Pace 9, 20122 Milano, Italy.
Telephone: +39-2-55035332 Fax: +39-2-50320747
Received: July 13, 2007
Revised: September 25, 2007
Accepted: October 26, 2007
Published online: December 14, 2007

Capsule endoscopy has revoluzionized the study of the small bowel by providing a reliable method to evaluate, endoscopically, the entire small bowel. In the last six years several papers have been published exploring the possible role of this examination in different clinical conditions. At the present time capsule endoscopy is generally recommended as a third examination, after negative bidirectional endoscopy, in patients with obscure gastrointestinal bleeding. A growing body of evidence suggests also an important role for this examination in other clinical conditions such as Crohn’s disease, celiac disease, small bowel polyposis syndromes or small bowel tumors. The main complication of this examination is the retention of the device at the site of a previously unknown small bowel stricture. However there are also some other open issues mainly due to technical limitations of this tool (which is not driven from remote control, is unable to take biopsies, to insufflate air, to suck fluids or debris and sometimes to correctly size and locate lesions).The recently developed double balloon enteroscope, owing to its capability to explore a large part of the small bowel and to take targeted biopsies, although being invasive and time consuming, can overcome some limitations of capsule endoscopy. At the present time, in the majority of clinical conditions (i.e. obscure GI bleeding), the winning strategy seems to be to couple these two techniques to explore the small bowel in a painless, safe and complete way (with capsule endoscopy) and to define and treat the lesions identified (with double balloon enteroscopy).

Keywords: Capsule endoscopy, Double balloon enteroscopy, Obscure glycemic index bleeding, Crohn's disease, Nonsteroidal anti-inflammatory drugs