Do We Underestimate Capsule Endoscopy in the Upper Gastrointestinal Tract?

ing. If done early in the course of the work-up, CE shortens the time to diagnosis and spares a number of alternative investigations with lower diagnostic yield. Taken together this seems appealing to doctors. A somewhat puzzling fact is that, in the majority of studies done so far for established indications, in only a small proportion of patients does CE have a real impact on the clinical outcome – even at a higher diagnostic yield. This clearly argues in favor of focused diagnostic strategies when considering CE for a work-up. In a way this contrasts with attempts to look for additional indications for CE – sometimes probably encouraged by the manufacturer with the aim to simply sell more CE devices. From the data presented so far we have no reason to believe that CE is of any help in the differential diagnosis of diffuse abdominal pain. Data presented from studies in patients with Crohn’s disease and polyposis syndromes seem interesting but have not really changed the diagnostic protocols. Here, modern enteroclysis techniques and double-balloon endoscopy are strong competitors. In this issue of Digestion , Peter et al. present an analysis of the frequency of lesions picked up in the esophagus and the stomach by CE compared to previous esophagogastroscopy (EGD) fi ndings. Although, the study has Since the fi rst upper gastrointestinal (GI) endoscopy was performed in 1881 by Mikulicz-Radecki, marked advances have been achieved in our ability to view the GI tract. The introduction of fl exible endoscopes facilitated intubation of deeper portions of the GI tract. However, for several decades endoscopy of the small bowel was rather limited to only a small portion of the closest upper bowel or tainted with a higher risk of complications when performing our so-called push endoscopies. Recently, a noninvasive method for examination of the small bowel has become available: capsule endoscopy (CE). The fi ction of movie makers of simply swallowing a tablet-like instrument and thereby traveling through the GI tract seems realistic. In 2001 the Given Imaging System got FDA approval in the United States. Since its introduction, several studies have been performed which demonstrated a certain superiority of this method above push endoscopy in the detection of lesions leading to obscure GI bleeding [1, 2] . The data presented to date clearly underline the usefulness of CE in the search for the sources of obscure GI bleeding. Pennazio et al. [3] evaluated the sensitivity and specifi city of CE and the outcome after CE in 100 consecutive patients with obscure GI bleeding, and reported that the procedure helps in situations with ongoing obscure-overt bleeding or with obscure-occult bleedPublished online: November 25, 2005