Authors' objectives:

This review was conducted in response to a request for advice from Health Services Division for the purpose of developing a funding policy for the use of capsule endoscopy (Given(R) Diagnostic Imaging System) in diagnostic work up of patients with gastrointestinal (GI) disease.

Authors' results and conclusions: - Most authors reported no difficulty by patients in swallowing the capsule. - Most of the authors have confirmed the safety of wireless capsule endoscopy (WCE). - The complication rate for WCE is low, the main complication being that the capsule may become entrapped in a stricture or an obstructed area during its passage in GI tract. - To date, obscure GI bleeding is the most widely accepted indication for WCE examination. - WCE has performed well in trials of patients with obscure GI bleeding. To date, a total of 286 WCE studies (two published studies & 9 clinical trials published in the form of abstracts) have shown superior results for WCE in diagnosing a source of bleeding as compared to the push entroscopy (PE). - WCE has produced superior results (one published study) in diagnosing the source of bleeding in small intestine compared to the barium follow through (BFT). - PE seems to have a greater sensitivity within the reach of push enteroscope but the overall sensitivity of WCE is higher because it has the ability to visualize the entire small bowel. - The results of two published studies have demonstrated the usefulness of WCE in suspected Crohn's disease - Contraindications for use include narrowing or blockage, fistula formation, diverticuli, implanted electromagnetic devices using radio frequency signals and cardiac pacemaker.

Authors' recommendations: WCE is a technological break through that allows the entire small bowel to be examined. WCE provides quality color images of the intestine, therefore, superficial and mucosal lesions such as ulcers, erosions, and arteriovenous malformations can be seen clearly. Based on the available data, WCE is indicated for use in the investigation of GI bleeding where the bleeding site is located in the small intestine and cannot be reached through upper or lower endoscopy. WCE is recommended to be used as an adjunctive technique, preceded by upper and lower endoscopy and small bowel radiography. WCE can help to reduce the number of diagnostic procedures in patients with chronic GI bleeding and negative upper and lower GI endoscopies.

Authors' methods: Systematic review

Project Status: Completed

Year Published: 2003

URL for published report: http://www.health.gov.on.ca/english/providers/program/mas/tech/reviews/pdf/rev_wce_050103.pdf

URL for additional information: http://www.hqontario.ca/evidence/publications-and-ohtac-recommendations/ohtas-reports-and-ohtac-recommendations/wireless-capsule-endoscopy

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Medical Advisory Secretariat

Contact Address: Medical Advisory Secretariat, 20 Dundas Street West, 10th Floor, Toronto, ON M5G 2N6 CANADA. Tel: 416-314-1092l; Fax: 416-325-2364;

Contact Name: MASinfo.moh@ontario.ca

Contact Email: MASinfo.moh@ontario.ca

Copyright: Medical Advisory Secretariat, Ontario Ministry of Health and Long-Term Care