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New vision in video capsule endoscopy: current status and future directions

Nature Reviews Gastroenterology & Hepatology volume 9, pages 392–405 (2012)Cite this article

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Abstract

Now, more than 10 years after the approval of video capsule endoscopy (VCE), the technology has become an essential component in the management of several clinical conditions. Currently, two capsules are approved in the USA for visualizing the small bowel mucosa, one capsule is authorized for oesophageal assessment and several others are in use or under evaluation worldwide. New investigations have focused on optical improvements, advances in intestinal cleansing and risk reduction strategies to optimize VCE methodologies in clinical care. Established indications diagnosed using VCE include unexplained gastrointestinal bleeding, small bowel Crohn's disease (in adults and children >10 years old), localization of small bowel tumours and a broad range of miscellaneous abnormalities. Investigations are ongoing to determine the utility of VCE in colon cancer screening, assessment of oesophageal disorders and diagnosis of coeliac disease. Active research is in progress into ways to improve the efficacy of VCE recording interpretation, prolong imaging time and further enhance optics and imaging methods. To expand the potential utility of VCE, novel devices that can manoeuvre within or insufflate the gut lumen, tag or biopsy suspect lesions, or target drug delivery to specific sites are in development. To facilitate these advances, consortia have been organized to promote innovative VCE technologies.

Key Points

  • Over 10 years after approval, video capsule endoscopy (VCE) remains the first-line diagnostic tool for visualizing small bowel mucosa; two capsules are FDA-approved, with other devices pending approval or in use worldwide

  • A capsule is available for detection of oesophageal mucosal abnormalities, but its limited accuracy and inability to biopsy or perform therapeutic techniques diminishes its usefulness when compared with upper endoscopy

  • Colon capsules can be used as an alternative to colonoscopy for cancer screening (although not approved in the USA), but lack the sensitivity, specificity and therapeutic advantages of colonoscopy

  • Established indications for small bowel VCE include evaluation of obscure gastrointestinal bleeding, small bowel Crohn's disease, small bowel tumours, polyposis syndromes and other mucosal abnormalities

  • Current improvements in VCE safety incorporate recommendations for patency capsule testing; enhancements in optics and imaging methods include technologies to highlight vascular lesions

  • Novel devices with possible future VCE applications are in development and include capacities for external manoeuvrability, tissue and optical biopsy, localization and tagging, and site-specific drug delivery

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Figure 1: Example FICE images of a small bowel adenoma.
Figure 2: Enhanced characterization of mucosal vascularity using white-light illumination.
Figure 3: Example FICE images of vascular and mucosal contrast of a small bowel angioectasia.
Figure 4: Prototype capsules with novel capabilities.

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Change history

  • 17 May 2012

    In the version of this article initially published online the author details for reference number 1 were incorrect and should have been attributed to Liao, Z., Gao, R., Xu, C. & Li, Z. S. The error has been corrected for the print, HTML and PDF versions of the article.

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Acknowledgements

The authors thank Patricia Lai and Vanessa Lawrence for administrative assistance.

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  1. Division of Gastroenterology, University of Michigan Health System, 3912 Taubman Center, 5362, Ann Arbor, 48109, MI, USA

    Laurel R. Fisher & William L. Hasler

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  1. Laurel R. Fisher
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Both authors contributed equally to all aspects of this manuscript.

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Correspondence to Laurel R. Fisher.

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Competing interests

L. R. Fisher declares that she has acted as a consultant for MiroCam and received grant or research support from Given Imaging. W. Hasler declares that he has acted as a consultant for SmartPill.

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Fisher, L., Hasler, W. New vision in video capsule endoscopy: current status and future directions. Nat Rev Gastroenterol Hepatol 9, 392–405 (2012). https://doi.org/10.1038/nrgastro.2012.88

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