Indications and possible fields of application

Indications

a) Mid gastrointestinal bleeding:
Obscure-overt, obscure-occult bleeding. Frequent findings. Bleeding relevance of lesions. Comparison of capsule endoscopy with other endoscopic and imaging techniques.
 

b) Crohn´s disease:
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 of retention.
 

c) 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.
 

d) Polyposis-syndromes:
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
 

e) Perspective indications:
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 colon.
 

f) 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.
 

Contraindications
 

Absolute
• Stenosis (consider a Patency-capsule)
• Diverticulosis
• Fistulas
• Pregnancy

Relative
• Inadequate bowel cleansing
• Odyno-or dysphagia
• Delayed gastric emptying (consider upper endoscopy and Delivery Device to explore capsule in duodenum)
• Motility disorders
• Pacemaker
• 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.