Exploring Blind Spots in Digestive Tract Examination: A Brief Discussion on Capsule Endoscopy!

History of small bowel capsule endoscopy

The development of small bowel capsule endoscopy revolutionized the diagnosis and treatment of small intestine and digestive diseases. It has been over 20 years since the first CE was swallowed by humans in 1999. In 2000, CE was approved by the FDA for clinical use and has played an important role in the diagnosis of small intestine diseases, evaluation of treatment efficacy, and determination of lesion locations. It is a primary examination method for small intestine diseases, favored by patients and clinicians for its painless, non-invasive characteristics. The indications for the examination continue to be refined through various clinical studies.

Since its inception, CE has made significant progress in terms of visual clarity, battery life, image capture frequency, and image viewing software.

Introduction to small bowel capsule endoscopy

Small intestine CE is a disposable capsule-shaped wireless examination tool that automatically captures images of the intestinal mucosa by advancing with the gastrointestinal motility. The captured images are wirelessly transmitted to the data recorder worn by the patient.

The small intestine CE examination system mainly consists of three parts: the capsule endoscope, the sensing system with a data recorder, and the computer workstation for image viewing and analysis.

Similar to other digestive endoscopic examinations, proper preparation of the intestines is crucial before small intestine CE examination. According to the small intestine endoscopy standards, fasting or consuming clear liquids is usually recommended within 8-12 hours before the examination.

Since it is not possible to inject water or air into the intestinal lumen like traditional endoscopy, the adequacy of intestinal preparation directly affects the completion rate of CE examination, image quality, and diagnostic efficiency.

Currently, major intestinal preparation approaches include bowel cleansing agents, defoaming agents, bowel cleansing agents combined with defoaming agents, and prokinetic drugs. When patients are unable to tolerate polyethylene glycol, the use of sodium phosphate salt as an alternative is recommended.

Defoaming agents are commonly used in gastroenterological examinations to remove gas bubbles adhering to the surface of the gastrointestinal mucosa to improve visibility. Currently, commonly used defoaming agents include simethicone and dimeticone, which change the surface tension of gas bubbles and cause them to burst, thereby eliminating the bubbles.

Although gastric and intestinal preparation (including bowel cleansing agents and defoaming agents) is commonly performed before the examination, the incomplete rate of small bowel capsule is still about 15% to 20%, and the use of prokinetic drugs remains a controversial issue.