Wireless capsule endoscopy

Clinical studies of wireless capsule endoscopy have focused on situations in which the traditional endoscope cannot visualize the entire length of the small bowel, as is the case for obscure intestinal bleeding, or recurrent bleeding of an origin not determined by the initial evaluation. Most of these studies have used the first camera approved by the FDA for the technique, which is produced by Given Imaging Ltd. of Yokneam, Israel.

Dr. Wael El-Matary of the University of Alberta in Edmonton, Canada, has reviewed these studies. He considered evaluations of adults and children with obscure intestinal bleeding. For adults, he found that wireless capsule endoscopy proved consistently superior to other techniques for identifying the source of the bleeding. For pediatric patients, he described promising results from the few case reports and studies available, but noted the need for larger comprehensive multicenter clinical trials.

The technique also proved reliable for examining the small intestine of patients with Crohn’s disease. However, in rare but serious cases, the camera became stuck and required removal by invasive surgery or by traditional endoscopy. Since then, the company has developed an improved version that can self-destruct on command. El-Matary stated that further evaluation of this version is needed.

He briefly evaluated other applications, such as hereditary polyp screening, abdominal pain and celiac disease, and mentioned the potential of the technique to examine tumors, graft rejections and more.

He concluded that wireless capsule endoscopy has proved so effective and safe that it is being investigated for new applications. Interpreting the images can take time, but nurses or technicians can be trained to do it. Most people preferred the pill camera to traditional endoscopy, although El-Matary stated that a few patients, especially children, may have difficulty swallowing it. (Journal of Pediatric Gastroenterology and Nutrition, January 2008, pp. 4-12.)