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Gastroenterology. 2017 Feb;152(3):497-514. doi: 10.1053/j.gastro.2016.12.032. Epub 2017 Jan 4.

Clinical Practice Guidelines for the Use of Video Capsule Endoscopy.

Author information

1
Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: renns@ubc.ca.
2
Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
3
Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
4
Section of Gastroenterology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
5
Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
6
Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
7
Division of Gastroenterology, Royal Alexandria Hospital, Edmonton, Alberta, Canada.

Abstract

BACKGROUND & AIMS:

Video capsule endoscopy (CE) provides a noninvasive option to assess the small intestine, but its use with respect to endoscopic procedures and cross-sectional imaging varies widely. The aim of this consensus was to provide guidance on the appropriate use of CE in clinical practice.

METHODS:

A systematic literature search identified studies on the use of CE in patients with Crohn's disease, celiac disease, gastrointestinal bleeding, and anemia. The quality of evidence and strength of recommendations were rated using the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach.

RESULTS:

The consensus includes 21 statements focused on the use of small-bowel CE and colon capsule endoscopy. CE was recommended for patients with suspected, known, or relapsed Crohn's disease when ileocolonoscopy and imaging studies were negative if it was imperative to know whether active Crohn's disease was present in the small bowel. It was not recommended in patients with chronic abdominal pain or diarrhea, in whom there was no evidence of abnormal biomarkers typically associated with Crohn's disease. CE was recommended to assess patients with celiac disease who have unexplained symptoms despite appropriate treatment, but not to make the diagnosis. In patients with overt gastrointestinal bleeding, and negative findings on esophagogastroduodenoscopy and colonoscopy, CE should be performed as soon as possible. CE was recommended only in selected patients with unexplained, mild, chronic iron-deficiency anemia. CE was suggested for surveillance in patients with polyposis syndromes or other small-bowel cancers, who required small-bowel studies. Colon capsule endoscopy should not be substituted routinely for colonoscopy. Patients should be made aware of the potential risks of CE including a failed procedure, capsule retention, or a missed lesion. Finally, standardized criteria for training and reporting in CE should be defined.

CONCLUSIONS:

CE generally should be considered a complementary test in patients with gastrointestinal bleeding, Crohn's disease, or celiac disease, who have had negative or inconclusive endoscopic or imaging studies.

KEYWORDS:

Capsule Endoscopy; Celiac Disease; Colonoscopy; Crohn’s Disease; Endoscopy; Gastrointestinal Bleeding; Video Capsule

PMID:
28063287
DOI:
10.1053/j.gastro.2016.12.032
[Indexed for MEDLINE]

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