Video capsule endoscopy of the small bowel (PillCam SB)

It is 4 years since capsule endoscopy was first introduced. This disposable 27 mm 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. In a relatively short period, capsule endoscopy has become an important investigative tool in patients with occult gastrointestinal bleeding, suspected small bowel tumors and other abnormalities. The aim of this review is to update the reader with the main indications, performance and complications of the technique.

There are some clear indications for capsule endoscopy: occult gastrointestinal bleeding, suspected small bowel tumor, suspected Crohn's disease, surveillance of inherited polyposis syndromes, drug-induced small bowel injury or any abnormal small bowel imaging. Problematic areas include defining what are normal findings and the inability to take biopsies and thus differentiate between entities.

Capsule endoscopy has become a first-line tool to detect abnormalities in the small bowel, and is superior to all other imaging technologies. Its interplay with the new technique of double balloon enteroscopy enables the small bowel to receive proper attention, similar to other gastrointestinal organs.