title: Clinical Practice Guidelines for the Use of Video Capsule Endoscopy.
abstract: Video capsule endoscopy (CE) provides a noninvasive option to assess the small intestine, but its use with respect to endoscopic procedures and cross-sectional imaging varies widely. The aim of this consensus was to provide guidance on the appropriate use of CE in clinical practice.
  
  
  
  A systematic literature search identified studies on the use of CE in patients with Crohn's disease, celiac disease, gastrointestinal bleeding, and anemia. The quality of evidence and strength of recommendations were rated using the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach.
  
  
  
  The consensus includes 21 statements focused on the use of small-bowel CE and colon capsule endoscopy. CE was recommended for patients with suspected, known, or relapsed Crohn's disease when ileocolonoscopy and imaging studies were negative if it was imperative to know whether active Crohn's disease was present in the small bowel. It was not recommended in patients with chronic abdominal pain or diarrhea, in whom there was no evidence of abnormal biomarkers typically associated with Crohn's disease. CE was recommended to assess patients with celiac disease who have unexplained symptoms despite appropriate treatment, but not to make the diagnosis. In patients with overt gastrointestinal bleeding, and negative findings on esophagogastroduodenoscopy and colonoscopy, CE should be performed as soon as possible. CE was recommended only in selected patients with unexplained, mild, chronic iron-deficiency anemia. CE was suggested for surveillance in patients with polyposis syndromes or other small-bowel cancers, who required small-bowel studies. Colon capsule endoscopy should not be substituted routinely for colonoscopy. Patients should be made aware of the potential risks of CE including a failed procedure, capsule retention, or a missed lesion. Finally, standardized criteria for training and reporting in CE should be defined.
  
  
  
  CE generally should be considered a complementary test in patients with gastrointestinal bleeding, Crohn's disease, or celiac disease, who have had negative or inconclusive endoscopic or imaging studies.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: renns@ubc.ca.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Enns
authors.affiliation: Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Hookey
authors.affiliation: Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Armstrong
authors.affiliation: Section of Gastroenterology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Charles N
authors.initials: CN
authors.lastname: Bernstein
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Heitman
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Teshima
authors.affiliation: Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Grigorios I
authors.initials: GI
authors.lastname: Leontiadis
authors.affiliation: Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Frances
authors.initials: F
authors.lastname: Tse
authors.affiliation: Division of Gastroenterology, Royal Alexandria Hospital, Edmonton, Alberta, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sadowski
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D053704:Capsule Endoscopy / Q000379:methods*; D002446:Celiac Disease / Q000175:diagnosis* / Q000473:pathology; D003113:Colonoscopy; D003424:Crohn Disease / Q000175:diagnosis* / Q000473:pathology; D016145:Endoscopy, Digestive System; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*
keywords: Capsule Endoscopy; Celiac Disease; Colonoscopy; Crohn’s Disease; Endoscopy; Gastrointestinal Bleeding; Video Capsule