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Controversies in … capsule endoscopy
  1. Suneil A Raju,
  2. Foong Way David Tai,
  3. Mark McAlindon
  1. Academic Unit of Gastroenterology and Hepatology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
  1. Correspondence to Dr Suneil A Raju, Gastroenterology and Liver Unit, The University of Sheffield, Sheffield S10 2TN, UK; suneilraju{at}gmail.com

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In our March #FGdebate we were joined by capsule endoscopy world experts: Professor McAlindon and Dr Tai who answered your questions and discussed the challenges of capsule endoscopy. This article summarises the main points covered in the Twitter debate.

Where are we with upper gastrointestinal capsule endoscopy?

Between 1% and 2% of the UK population undergo gastroscopy per annum and there has been a 30% increase in demand since the publication of the National Institute of Clinical Excellence guidance for dyspepsia in 2004 (CG141).1 Despite this, in dyspeptic patients, over 70% of patients have normal gastroscopies.2 Upper gastrointestinal (GI) capsules can be controlled by patient position changes (Pillcam UGI, Medtronic, Minneapolis, USA) and good views can be achieved 80% of the time, but require a separate reading session lasting a mean of 48 min.3 On the other hand, using handheld magnets to control upper GI capsules (Mirocam Navi, Intromedic, Seoul, Korea) allows a live examination. In a single blinded comparative study of recurrent or refractory iron deficiency anaemia, patients reported better tolerance to capsule endoscopy and clinicians found more lesions likely to cause iron deficiency on capsule endoscopy than gastroscopy. Mean magnet capsule examination time by the operator was 23 min. Finally, magnetic capsules can be robot controlled (Navicam, Ankon). In 350 patients with upper GI complaints, Liao et al4 report a 90% sensitivity in detecting focal lesions in the stomach-controlled capsules when compared with conventional gastroscopy in a multicentre study in China. This information is summarised in Box 1.

Box 1

Capsule endoscopy quick facts

How is the capsule controlled?

  • Patient position changes.

  • Hand held magnets (23 min operator time).

  • Robot controlled magnets.

How long does it take to travel through the small bowel?

  • 4 hours through the small bowel.

Can they take biopsies?

  • In pig models only: not yet …

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