title: Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.
abstract: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Guideline was also reviewed and endorsed by the British Society of Gastroenterology (BSG). It addresses the roles of small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders. Main recommendations 1 ESGE recommends small-bowel video capsule endoscopy as the first-line investigation in patients with obscure gastrointestinal bleeding (strong recommendation, moderate quality evidence). 2 In patients with overt obscure gastrointestinal bleeding, ESGE recommends performing small-bowel capsule endoscopy as soon as possible after the bleeding episode, optimally within 14 days, in order to maximize the diagnostic yield (strong recommendation, moderate quality evidence). 3 ESGE does not recommend the routine performance of second-look endoscopy prior to small-bowel capsule endoscopy; however whether to perform second-look endoscopy before capsule endoscopy in patients with obscure gastrointestinal bleeding or iron-deficiency anaemia should be decided on a case-by-case basis (strong recommendation, low quality evidence). 4 In patients with positive findings at small-bowel capsule endoscopy, ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by capsule endoscopy (strong recommendation, high quality evidence). 5 ESGE recommends ileocolonoscopy as the first endoscopic examination for investigating patients with suspected Crohn's disease (strong recommendation, high quality evidence). In patients with suspected Crohn's disease and negative ileocolonoscopy findings, ESGE recommends small-bowel capsule endoscopy as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known stenosis (strong recommendation, moderate quality evidence).ESGE does not recommend routine small-bowel imaging or the use of the PillCam patency capsule prior to capsule endoscopy in these patients (strong recommendation, low quality evidence). In the presence of obstructive symptoms or known stenosis, ESGE recommends that dedicated small bowel cross-sectional imaging modalities such as magnetic resonance enterography/enteroclysis or computed tomography enterography/enteroclysis should be used first (strong recommendation, low quality evidence). 6 In patients with established Crohn's disease, based on ileocolonoscopy findings, ESGE recommends dedicated cross-sectional imaging for small-bowel evaluation since this has the potential to assess extent and location of any Crohn's disease lesions, to identify strictures, and to assess for extraluminal disease (strong recommendation, low quality evidence). In patients with unremarkable or nondiagnostic findings from such cross-sectional imaging of the small bowel, ESGE recommends small-bowel capsule endoscopy as a subsequent investigation, if deemed to influence patient management (strong recommendation, low quality evidence). When capsule endoscopy is indicated, ESGE recommends use of the PillCam patency capsule to confirm functional patency of the small bowel (strong recommendation, low quality evidence). 7 ESGE strongly recommends against the use of small-bowel capsule endoscopy for suspected coeliac disease but suggests that capsule endoscopy could be used in patients unwilling or unable to undergo conventional endoscopy (strong recommendation, low quality evidence).
authors.affiliation: Division of Gastroenterology, San Giovanni Battista University Teaching Hospital, Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Pennazio
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Spada
authors.affiliation: Department of Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University Tel-Hashomer, Israel.
authors.forename: Rami
authors.initials: R
authors.lastname: Eliakim
authors.affiliation: Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Hamburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Keuchel
authors.affiliation: Department of Medicine II, Sana Klinikum, Offenbach, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: May
authors.affiliation: Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Mulder
authors.affiliation: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Rondonotti
authors.affiliation: Division of Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Samuel N
authors.initials: SN
authors.lastname: Adler
authors.affiliation: Department of Medicine I, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Albert
authors.affiliation: Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Hamburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Baltes
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Barbaro
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service d'Hépato-gastro-entérologie, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Cellier
authors.affiliation: Medizinische Klinik, Evangelisches Krankenhaus, Düsseldorf, Germany.
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Charton
authors.affiliation: Department of Hepato-Gastroenterology, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Delvaux
authors.affiliation: Royal Free Unit for Endoscopy and Centre for Gastroenterology, The Royal Free Hospital and University College London, London, UK.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Despott
authors.affiliation: Department of Medicine B, University of Münster, Münster, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Domagk
authors.affiliation: Institute of Gastroenterology and Liver Diseases, Ha'emek Medical Center Afula, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology Haifa, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Klein
authors.affiliation: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: McAlindon
authors.affiliation: Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal.
authors.forename: Bruno
authors.initials: B
authors.lastname: Rosa
authors.affiliation: Clinical Psychology Unit, Department of Psychology, University of Sheffield.
authors.forename: Georgina
authors.initials: G
authors.lastname: Rowse
authors.affiliation: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
authors.affiliation: Centre Hospitalier Lyon Sud, Pierre Bénite, Lyon, France.
authors.forename: Jean Christophe
authors.initials: JC
authors.lastname: Saurin
authors.affiliation: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors.forename: Reena
authors.initials: R
authors.lastname: Sidhu
authors.affiliation: Gedyt Endoscopy Center, Buenos Aires, Argentina.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Dumonceau
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Institute of Gastroenterology and Liver Diseases, Ha'emek Medical Center Afula, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology Haifa, Israel.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Gralnek
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000175:diagnosis; D018798:Anemia, Iron-Deficiency / Q000209:etiology; D053704:Capsule Endoscopy; D002446:Celiac Disease / Q000175:diagnosis; D003424:Crohn Disease / Q000175:diagnosis; D058582:Double-Balloon Enteroscopy; D004378:Duodenal Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007077:Ileal Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D007414:Intestinal Neoplasms / Q000150:complications / Q000175:diagnosis*; D007579:Jejunal Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D010580:Peutz-Jeghers Syndrome / Q000175:diagnosis; D011159:Population Surveillance / Q000379:methods*