Hale Melissa F, Sidhu Reena, McAlindon Mark E
Melissa F Hale, Reena Sidhu, Mark E McAlindon, Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield S10 2JF, United Kingdom.
World J Gastroenterol. 2014 Jun 28;20(24):7752-9. doi: 10.3748/wjg.v20.i24.7752.
Capsule endoscopy (CE) has transformed investigation of the small bowel providing a non-invasive, well tolerated means of accurately visualising the distal duodenum, jejunum and ileum. Since the introduction of small bowel CE thirteen years ago a high volume of literature on indications, diagnostic yields and safety profile has been presented. Inclusion in national and international guidelines has placed small bowel capsule endoscopy at the forefront of investigation into suspected diseases of the small bowel. Most commonly, small bowel CE is used in patients with suspected bleeding or to identify evidence of active Crohn's disease (CD) (in patients with or without a prior history of CD). Typically, CE is undertaken after upper and lower gastrointestinal flexible endoscopy has failed to identify a diagnosis. Small bowel radiology or a patency capsule test should be considered prior to CE in those at high risk of strictures (such as patients known to have CD or presenting with obstructive symptoms) to reduce the risk of capsule retention. CE also has a role in patients with coeliac disease, suspected small bowel tumours and other small bowel disorders. Since the advent of small bowel CE, dedicated oesophageal and colon capsule endoscopes have expanded the fields of application to include the investigation of upper and lower gastrointestinal disorders. Oesophageal CE may be used to diagnose oesophagitis, Barrett's oesophagus and varices but reliability in identifying gastroduodenal pathology is unknown and it does not have biopsy capability. Colon CE provides an alternative to conventional colonoscopy for symptomatic patients, while a possible role in colorectal cancer screening is a fascinating prospect. Current research is already addressing the possibility of controlling capsule movement and developing capsules which allow tissue sampling and the administration of therapy.
胶囊内镜(CE)改变了小肠检查方式,提供了一种非侵入性、耐受性良好的手段,可准确观察十二指肠远端、空肠和回肠。自13年前小肠CE问世以来,已有大量关于适应证、诊断率和安全性的文献发表。被纳入国家和国际指南使小肠胶囊内镜处于疑似小肠疾病调查的前沿。最常见的是,小肠CE用于疑似出血患者或识别活动性克罗恩病(CD)的证据(无论患者有无CD病史)。通常,在上下消化道柔性内镜检查未能明确诊断后进行CE。对于有狭窄高风险的患者(如已知患有CD或出现梗阻症状的患者),在进行CE之前应考虑小肠放射学检查或通畅性胶囊试验,以降低胶囊滞留的风险。CE在乳糜泻、疑似小肠肿瘤和其他小肠疾病患者中也有作用。自小肠CE出现以来,专用的食管和结肠胶囊内镜扩大了应用领域,包括对上、下消化道疾病的检查。食管CE可用于诊断食管炎、巴雷特食管和静脉曲张,但在识别胃十二指肠病变方面的可靠性尚不清楚,且它没有活检能力。结肠CE为有症状的患者提供了传统结肠镜检查的替代方法,而在结直肠癌筛查中的潜在作用是一个令人着迷的前景。目前的研究已经在探讨控制胶囊运动以及开发能够进行组织取样和实施治疗的胶囊的可能性。