Small-bowel capsule endoscopy (SBCE)
 1 ESGE recommends that prior to SBCE patients ingest a purgative (2 L of polyethylene glycol [PEG]) for better visualization. Strong recommendation, high quality evidence. However, the optimal timing for taking purgatives is yet to be established. 2 ESGE recommends that SBCE should be performed as an outpatient procedure if possible, since completion rates are higher in outpatients than in inpatients. Strong recommendation, moderate quality evidence. 3 ESGE recommends that patients with pacemakers can safely undergo SBCE without special precautions. Strong recommendation, low quality evidence. 4 ESGE suggests that SBCE can also be safely performed in patients with implantable cardioverter defibrillators and left ventricular assist devices. Weak recommendation, low quality evidence. 5 ESGE recommends the acceptance of qualified nurses and trained technicians as prereaders of capsule endoscopy studies as their competency in identifying pathology is similar to that of medically qualified readers. The responsibility of establishing a diagnosis must however remain with the attending physician. Strong recommendation, moderate quality evidence. 6 ESGE recommends observation in cases of asymptomatic capsule retention. Strong recommendation, moderate quality evidence. In cases where capsule retrieval is indicated, ESGE recommends the use of device-assisted enteroscopy as the method of choice. Strong recommendation, moderate quality evidence. Device-assisted enteroscopy (DAE)
 1 ESGE recommends performing diagnostic DAE as a day-case procedure in patients without significant underlying co-morbidities; in patients with co-morbidities and/or those undergoing a therapeutic procedure, an inpatient stay is recommended. Strong recommendation, low quality evidence The choice between different settings also depends on sedation protocols. Strong recommendation, low quality evidence. 2 ESGE suggests that conscious sedation, deep sedation, and general anesthesia are all acceptable alternatives: the choice between them should be governed by procedure complexity, clinical factors, and local organizational protocols. Weak recommendation, low quality evidence. 3 ESGE recommends that the findings of previous diagnostic investigations should guide the choice of insertion route. Strong recommendation, moderate quality evidence. If the location of the small-bowel lesion is unknown or uncertain, ESGE recommends that the antegrade route should be generally preferred. Strong recommendation, low quality evidence. In the setting of massive overt bleeding, ESGE recommends an initial antegrade approach. Strong recommendation, low quality evidence. 4 ESGE recommends that, for balloon-assisted enteroscopy (i. e., single-balloon enteroscopy [SBE] and double-balloon enteroscopy [DBE]), small-bowel insertion depth should be estimated by counting net advancement of the enteroscope during the insertion phase, with confirmation of this estimate during withdrawal. Strong recommendation, low quality evidence. ESGE recommends that, for spiral enteroscopy, insertion depth should be estimated during withdrawal. Strong recommendation, moderate quality evidence. Since the calculated insertion depth is only a rough estimate, ESGE recommends placing a tattoo to mark the identified lesion and/or the deepest point of insertion. Strong recommendation, low quality evidence. 5 ESGE recommends that all endoscopic therapeutic procedures can be undertaken at the time of DAE. Strong recommendation, moderate quality evidence. Moreover, when therapeutic interventions are performed, additional specific safety measures are needed to prevent complications. Strong recommendation, high quality evidence.

/pdf/small-bowel-capsule-endoscopy-and-device-assisted-4dltzyt3z1.pdf

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

https://www.spg.pt/wp-content/uploads/2015/11/2013-JCC_ECCO_Endoscopy_Consensus_10_2013_inPress.pdf

European evidence based consensus for endoscopy in inflammatory bowel disease

Clinical Practice Guidelines for the Use of Video Capsule Endoscopy

Video capsule endoscopy (VCE) has revolutionized the diagnostic work-up in the field of small bowel diseases. Furthermore, VCE has the potential to become the leading screening technique for the entire gastrointestinal tract. Computational methods that can be implemented in software can enhance the diagnostic yield of VCE both in terms of efficiency and diagnostic accuracy. Since the appearance of the first capsule endoscope in clinical practice in 2001, information technology (IT) research groups have proposed a variety of such methods, including algorithms for detecting haemorrhage and lesions, reducing the reviewing time, localizing the capsule or lesion, assessing intestinal motility, enhancing the video quality and managing the data. Even though research is prolific (as measured by publication activity), the progress made during the past 5 years can only be considered as marginal with respect to clinically significant outcomes. One thing is clear-parallel pathways of medical and IT scientists exist, each publishing in their own area, but where do these research pathways meet? Could the proposed IT plans have any clinical effect and do clinicians really understand the limitations of VCE software? In this Review, we present an in-depth critical analysis that aims to inspire and align the agendas of the two scientific groups.

Software for enhanced video capsule endoscopy: challenges for essential progress

Deep learning for wireless capsule endoscopy: a systematic review and meta-analysis

Background and aim Data about small bowel capsule endoscopy (SBCE) come from studies involving small and highly selected populations. The study aim was to describe extent of use, indications, results, complications, and practical issues of SBCE in clinical practice in a Northern Italian Region (Lombardia). Materials and methods Twenty-three out of 29 invited centers fulfilled a specific questionnaire. Results Between 2001 and 2008, 2921 procedures were performed and both the number of centers performing SBCE (from 5 to 29) and the number of SBCE (from 7.2 to 69.2 per month) increased steadily. The main indications for SBCE were: obscure gastrointestinal bleeding (OGIB) (43.4%), unexplained anemia (23.9%), suspected Crohn's disease (7.8%) and abdominal pain (5.3%). Overall, SBCE was positive in 50% of cases, negative in 36% and undefined in 14%. The highest diagnostic yields were observed in patients with OGIB (62.5%), polypoid syndromes (74.1%), known (54.8%) or suspected (47.3%) inflammatory bowel disease, while the yields were low in patients examined for chronic diarrhea (27.4%) and abdominal pain (14.9%), 61 patients (2.1%) experienced capsule retention. Thirty-two of them eventually excreted the capsule naturally while endoscopic or surgical retrieval was necessary in 29 (1%) (in two because of obstruction). Conclusion Over a period of 7 years the use of SBCE in Lombardia increased steadily confirming, in clinical practice, a high diagnostic yield and an acceptable safety profile.

Small bowel capsule endoscopy in clinical practice: a multicenter 7-year survey.

P.07.2 small bowel capsule endoscopy (sbce) complications: frequency, management and policy to prevent them. prospective data froma regional registry (registro lombardo delle complicanze)

Can we improve the detection rate and interobserver agreement in capsule endoscopy

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Small bowel capsule endoscopy in clinical practice: a multicenter 7-year survey.

P.07.2 small bowel capsule endoscopy (sbce) complications: frequency, management and policy to prevent them. prospective data froma regional registry (registro lombardo delle complicanze)

Can we improve the detection rate and interobserver agreement in capsule endoscopy