Indications and possible fields of application
Mid gastrointestinal bleeding:
Obscure-overt, obscure-occult bleeding.
Frequent findings. Bleeding relevance of lesions.
Comparison of capsule endoscopy with other
endoscopic and imaging techniques.
Suspected Crohn´s disease after negative conventional work-up as
upper and lower GI endoscopy. Discussion of additional tests
probably required prior to VCE by the clinical situation (as
sonography, SBFT, Enteroclysis, CT, MRI). Balanced presentation of
pros and cons of VCE in established Crohn´s disease and in
indeterminate colitis, considering potential benefit as well as risk
Celiac sprue and refractory sprue:
Presentation of endoscopic findings in
sprue. Discussion of application of capsule endoscopy in sprue.
Duodenal biopsy and antibody tests as gold standard in the primary
diagnosis of celiac sprue. Role of capsule endoscopy in patients
with persistant complaints or symptoms (anemia) inspite of
gluten-free diet, suspicion of lymphoma.
Short description of the relevant
syndromes (Peutz-Jeghers syndrom, familial
adenomatouspPolyposis FAP). Discussion of prevalence of jejunal and
ileal polyps in FAP patients with and without duodenal polyps.
Considering previous abdominal operations in these patients
Potential application of VCE for
monitoring of therapy after small bowel transplantation, for
diagnosis of intestinal graft versus host disease, in patients with
hereditary non polyposis colon carcinoma, melanoma oder
neuroendocrine tumours, staging and restaging of lymphoma, and
other rare diseases associated with malabsorption.
Application of VCE in other organs as esophagus andd
Abdominal pain and / or diarrhea:
Critical discussion of potential application of VCE in patients with
abdominal pain and / or diarrhea. Differentiation between irritable
bowel syndrome on one hand and inflammatory, stenosing or tumorous
lesions on the other hand by considering additional symptoms or
findings as signs of inflammation, anemia, weight loss etc.
• Stenosis (consider a Patency-capsule)
• Inadequate bowel cleansing
• Odyno-or dysphagia
• Delayed gastric emptying (consider upper endoscopy and Delivery
Device to explore capsule in duodenum)
• Motility disorders
• Use of any medication deteriorating motility
Required diagnostic test prior to capsule endoscopy
(Always: EGD and colonoscopy, better ileo-colonoscopy) Additional
tests if stenosis is suspected,as side viewing duodenoscopy in FAP
patients, and optionally in patients with obscure GI bleeding.