Video capsule endoscopy of the small bowel

Purpose of review It is now more than 6 years since capsule endoscopy was first introduced to the gastroenterological community. This disposable 26 x 11 mm video capsule, containing its own optical dome, light source, batteries, transmitter and antenna, is swallowed with water after a 12 h fast. The capsule is propelled via peristalsis through the gastrointestinal tract, capturing about 60 000 digital images, and is excreted naturally. Capsule endoscopy has become a first-line tool for detecting abnormalities in the small bowel, because all other imaging technologies are rather ineffective. This review covers recent developments in capsule endoscopy technology and provides an update of its main indications. Recent findings There are some clear indications for capsule endoscopy: obscure gastrointestinal bleeding, suspected small bowel tumour (in which it is becoming a primary investigational tool), suspected Crohn's disease, surveillance of inherited polyposis syndromes, drug-induced small bowel injury, and any abnormal small bowel imaging. Controversy persists regarding what is a normal small bowel appearance, which is exacerbated by the inability to take biopsies and thus differentiate between entities; with technological advances, however, it is hoped that this will be addressed. Summary Capsule endoscopy has been incorporated into the gastroenterologists' daily life, changing the approach to many small bowel pathologies.