[Bowel imaging--capsule endoscopy]

The small bowel has ever since been the "black box" of endoscopy. The long distance from mouth to anus limits the use of conventional endoscopy for the multiple complex looped configurations. For some years now the new technology of wireless capsule endoscopy allows the endoscopic imaging of the complete small bowel. After ingestion of a small pill-size video capsule a continuous series of images is transmitted to an external recorder, whose data can be reviewed after completion of the examination. Compared to other diagnostic tools like push-enteroscopy, capsule endoscopy proves higher diagnostic yield for the detection of bleeding sources in obscure gastrointestinal bleeding. Its results for this task seem to be comparable to those of intraoperative endoscopy, so far considered as gold standard. Capsule endoscopy also opens up new horizons in diagnosing different small-bowel affections like Crohn's disease and polyposis syndromes. Complication rate is low, the main problem being the entrapment of the capsule in a previous unknown stricture which limits its use in Crohn's disease considerably. To date capsule endoscopy needs further evaluation in respect to outcome and cost-effectiveness in order to confirm its role as an important diagnostic tool for the small bowel.