Authors' objectives:

The aim of this report was to evaluate the clinical efficacy and cost-effectiveness of capsule endoscopy (CE) as compared to other diagnostic modalities on different potential indications such as obscure gastrointestinal bleeding (OGIB), Crohn's disease (CD), intestinal polyposis and Celiac disease.

Authors' results and conclusions: For diagnosis of bleeding sources in patients with obscure gastrointestinal bleeding (OGIB), there is evidence of diagnostic accuracy. The diagnostic yield of CE is generally higher when compared to other diagnostic modalities, but patient selection bias is present in most studies. Limited data suggest that the yield of CE is highest in overt ongoing bleeding, intermediate in overt previous bleeding and intermediate or low in occult bleeding. Capsule retention necessitating surgical or endoscopic removal occurred in 0.7-5% of the patients in a trial setting. CE failed to reach the caecum within the battery lifetime in 17-34% of the patients. In patients with suspected or established Crohn's disease (CD) small and heterogeneous patient populations were evaluated in the different studies (CD and/or suspected CD, different previous investigations, different comparators ) which prevents generalisability of results. It is unclear which patients would benefit from CE. Future studies should address potential fields of application and their significance. The problem of false positives should be resolved. Constituting a catalog with normal and pathological CE findings is essential. Capsule retention with CE is more likely to occur in CD patients, even after a negative radiological evaluation. In such cases, unintended surgery may be required to remove the capsule. Capsule retention with CE is more likely to occur in CD patients, even after a negative radiological evaluation. In such cases, unintended surgery may be required to remove the capsule. CE failed to reach the caecum within the battery lifetime in 17.5% of the patients and thus the terminal ileum, a critical segment for CD, was not visualised in these patients.

Authors' recommendations: CE is recommended in patients with OGIB (when a previous ileocolonoscopy and esophagogastroduodenoscopy were negative). The most important risk related to CE is capsule retention necessitating unintended surgical or endoscopic removal. Patients should be informed on this risk prior to CE. For reasons of volume and quality, the implementation of CE in Belgium should be limited to a few centres only. The expected maximum budget for CE in Belgium for OGIB is estimated at 600,000 Euro after 5 years. At present, the available evidence is not of sufficient quantity and quality to determine the relative diagnostic performance of CE compared with alternative conventional diagnostic tests in diagnosing patients with CD, intestinal polyposis and Celiac disease. No conclusions can be made as to whether CE is an effective alternative to other tests. Further research is warranted to determine the place of CE in the management algorithm of OGIB and on other potential indications for CE such as CD, intestinal polyposis and celiac disease.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.kce.fgov.be/index_en.aspx?SGREF=5220&CREF=9320

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Belgium

Organisation Name: Belgian Health Care Knowledge Centre

Contact Address: Administrative Centre Botanique, Doorbuilding (10th floor), Boulevard du Jardin Botanique 55, B-1000 Brussels, Belgium tel: +32 2 287 33 88 fax: +32 2 287 33 85

Contact Name: info@kce.fgov.be

Contact Email: info@kce.fgov.be

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