Small bowel capsule endoscopy: Where are we after almost 15 years of use?

Table 1 Comparison between commercially available capsule endoscopy devices

Capsule	PillCam® SB 3 Given Imaging	EndoCapsule® Olympus America	MiroCam® Intromedic Company	OMOM® Jianshan Science and Technology
Size	Length: 26.2 mmDiameter: 11.4 mm	Length: 26 mm Diameter: 11 mm	Length: 24.5 mmDiameter: 10.8 mm	Length: 27.9 mmDiameter: 13 mm
Weight	3.00 g	3.50 g	3.25-4.70 g	6.00 g
Battery life	8 h or longer	8 h or longer	11 h or longer	6-8 h or longer
Resolution	340 x 34030% better than SB2	512 x 512	320 x 320	640 x 480
Frames per second	2 fps or 2-6 fps	2 fps	3 fps	2 fps
Field of view	156°	145°	170°	140°
Communication	Radio Frequency Communication	Radio Frequency Communication	Human Body Communication	Radio Frequency Communication
FDA approval	Yes	Yes	Yes	No
Price per capsule	$500	$500	$500	$250

Table 2 Comparison of different diagnostic modalities in obscure gastrointestinal bleeding

Ref.	Country	Design	No. of patients	Comparator	Yield of CE, (%)	Yield of Comparator, (%)	Significant difference? (yes/no)	CE superior? (yes/no)	Other
Triester et al[80]	United States	Meta-analysis and Systematic review	396	PE	63	28	Yes	Yes	NNT = 3 to yield one additional clinically significant finding with CE
			88	SB radiography (barium contrast and enteroclysis)	67	8	Yes	Yes	NNT = 3 to yield one additional clinically significant finding with CE
Leighton et al[82]	United States	Meta-analysis and Systematic review	396	PE	63	28	Yes	Yes	Yield of significant findings: CE = 56% vs PE = 26%, NNT = 3 to yield one additional clinically significant finding with CE
			88	Barium radiography	67	8	Yes	Yes	Yield of significant findings: CE = 42% vs SB barium radiography = 6%, NNT = 3 to yield one additional clinically significant finding with CE
			42	Intraoperative enteroscopy	83	83	No	No
			17	Mesenteric angiography	47	53	No	No
Chen et al[205]	China	Meta-analysis and Systematic review	277	DBE	61	56	No	No	CE was superior if no combination of oral + anal approach <-> DBE was superior when a combination of the two insertion approaches was done
Pasha et al[95]	United States	Meta-analysis and Systematic review	397	DBE	24	24	No	No	CE should be the initial diagnostic test for determining insertion route of DBE
Arakawa et al[76]	Japan	Retrospective Study	162	DBE	54	64	No	No
Teshima et al[77]	Canada, The Netherlands	Meta-analysis and Systematic review	651	DBE	62	56	No	Yes	Yield of DBE after positive CE = 75.0% <-> yield after negative CE = 27.5%
Leung et al[206]	China	RCT	60	Mesenteric angiography	53	20	Yes	Yes	No significant difference in the long-term outcomes (transfusion need, hospitalization for rebleeding,mortality)
Wang et al[207]	China	Meta-analysis and Systematic review	279	CT	53	34	Yes	Yes	Complementary role to CE and can be used as a triage tool prior to DBE in evaluating OGIB

PE: Push enteroscopy; CE: Capsule endoscopy; SB: Small bowel; NNT: Number needed to treat; DBE: Double balloon enteroscopy; RCT: Randomized controlled trial.

Table 3 Comparison of different diagnostic modalities in Crohn’s disease

Ref.	Country	Design	No. of patients	Comparator	Yield of CE, (%)	Yield of Comparator, (%)	Significant difference? (yes/no)	CE superior? (yes/no)	Other
Marmo et al[117]	Italy	RCT	31	SB radiography (enteroclysis)	71	26	Yes	Yes	Terminal ileum: yield 89% vs 37% Proximal SB: yield only 46% vs 13%
Chong et al[208]	Australia	Blinded prospective trial	43	SB enteroclysis PE	77 77	19 14	Yes Yes	Yes Yes	Results are in patients with a history of CD
Triester et al[81]	United States	Meta-analysis and Systematic review	250	SB barium radiography	63	23	Yes	Yes	NNT = 3 to yield one additional diagnosis with CE
			114	Colonoscopy with ileoscopy	61	46	Yes	Yes	NNT = 7 to yield one additional diagnosis with CE
			93	CT enterography/CT enteroclysis	69	30	Yes	Yes
			84	PE	46	8	Yes	Yes
			18	MR enterography	72	50	No	Yes
Solem et al[118]	United States	Blinded prospective trial	41	CT enterography Colonoscopy with ileoscopy Small bowel follow-through	83 83 83	83 74 65	No No No	No Yes Yes	Specificity of CE (53%) was significantly lower than the other tests
Pasha et al[95]	United States	Meta-analysis and Systematic review	343	DBE	18	16	No	No
Dionisio et al[115]	United States	Meta-analysis and Systematic review	428	SB barium radiography	52	16	Yes	Yes
			236	Colonoscopy with ileoscopy	47 (71)1	25 (36)	Yes	Yes	Suspected CD (Established CD)
			119	CT enterography	68 (71)	21 (39)	Yes	Yes	Suspected CD (Established CD)
			102	PE	66	9	Yes	Yes	Established CD
			123	MR enterography	55 (70)	45 (79)	No	Yes (no)	Suspected CD (Established CD)
Lu et al[116]	China	Retrospective Study	50	Colonoscopy with ileoscopy	96	66	Yes	Yes	Combination of two methods showed a higher yield, but no significant differences were reported between each two examinations
			34	CT enterography	96	85	Yes	Yes
			39	Small bowel follow-through	96	67	Yes	Yes

¹Extra information between brackets is specific for Established Crohn’s disease. PE: Push enteroscopy; CE: Capsule endoscopy; SB: Small bowel; NNT: Number needed to treat; DBE: Double balloon enteroscopy; RCT: Randomized controlled trial.