A Comprehensive Overview of the Application of Small Bowel Capsule Endoscopy in Disease Diagnosis

Small bowel capsule endoscopy is widely used in clinical practice and has become the first-line examination method for small bowel diseases. The guidelines mainly propose the following statements regarding the application of small bowel capsule endoscopy in disease diagnosis.

Use small bowel capsule endoscopy for small bowel bleeding

After excluding contraindications, small bowel capsule endoscopy is recommended as the first-line screening method for patients suspected of small bowel bleeding.

For patients suspected of small bowel bleeding, if imaging examinations do not support lesions such as small bowel tumors or diverticula, it is recommended to perform capsule endoscopy as soon as possible after excluding contraindications to improve diagnostic efficiency.

For patients suspected of small bowel bleeding with negative small bowel capsule endoscopy results, if there is persistent bleeding or the need for transfusion therapy, it is recommended to undergo repeat examinations such as capsule endoscopy, small bowel endoscopy, imaging studies, and angiography. If there is no persistent bleeding, conservative treatment can be performed followed by observation.

Use small bowel capsule endoscopy for iron deficiency anemia (IDA)

Before performing capsule endoscopy on IDA patients, detailed medical history should be obtained (including premenopausal women's medication use, complications, gynecological history), and further examinations such as gastroscopy and colonoscopy should be completed.

When gastroscopy and colonoscopy cannot identify the lesions and it is necessary to evaluate small bowel lesions, it is recommended to perform small bowel capsule endoscopy after excluding possible obstructions.

Use small bowel capsule endoscopy for Crohn's disease

For patients suspected of Crohn's disease with negative colonoscopy results, it is recommended to perform capsule endoscopy when there are no symptoms of obstruction or known intestinal stenosis.

For patients suspected of Crohn's disease with negative colonoscopy results, it is recommended to routinely perform small bowel imaging examinations before small bowel capsule endoscopy.

For patients suspected of Crohn's disease, it is recommended to carefully select appropriate patients based on clinical history, serological tests, and fecal inflammatory marker examination results before small bowel capsule endoscopy to improve the diagnostic efficiency for active Crohn's disease in the small intestine. Routine capsule endoscopy is not recommended for patients with only chronic abdominal pain or diarrhea symptoms and no obvious abnormalities in biological indicators.

According to colonoscopy results, for confirmed Crohn's disease patients, it is recommended to perform small bowel imaging examinations to evaluate the extent and location of intestinal lesions, identify stenosis, and evaluate extraluminal lesions. If there are no significant positive results, small bowel capsule endoscopy can be performed.

For suspected Crohn's disease patients with capsule retention, the location of retention should be determined first. Depending on the patient's condition, conservative drug treatment is recommended first. If the capsule is not excreted, further assistance with enteroscopy should be performed to remove the capsule. If obstructions occur, surgical removal can be considered.

For Crohn's disease patients during follow-up, it is recommended to use the Lewis score or Crohn's Disease Activity Index to assess the patient's condition and response to medication.

For Crohn's disease patients suspected of recurrence after colon resection but unable to be diagnosed by colonoscopy and imaging examinations, if contraindications such as strictures are excluded by intestinal imaging examinations, small bowel capsule endoscopy is recommended.