Gastroenterology

Gastroenterology

Volume 152, Issue 3, February 2017, Pages 497-514
Gastroenterology

Guideline
Clinical Practice Guidelines for the Use of Video Capsule Endoscopy

https://doi.org/10.1053/j.gastro.2016.12.032Get rights and content

Background & Aims

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.

Methods

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.

Results

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.

Conclusions

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.

Section snippets

Scope and Purpose

This consensus was focused on specific questions regarding the use of CE as identified and discussed by the participants. Development of this clinical practice guideline was initiated in November 2014, with a meeting of the full consensus group held in November 2015. The entire process took approximately 20 months, with the final manuscript being submitted for publication in July 2016.

Sources and Searches

The Editorial Office of the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group at McMaster

Recommendation Statements

The individual recommendation statements are provided and include the GRADE of supporting evidence and the voting results, after which, a discussion of the evidence considered for the specific statement is presented. For the majority of statements the quality of evidence was determined to be very low, largely because of high risk of bias, indirectness, and imprecision. For some statements in which lower quality of evidence exists, a strong recommendation was made based on other factors such as

Future Directions

Although CE has advanced substantially as an important procedure to visualize the small-bowel mucosa, certain knowledge gaps have an important impact on the use of CE. Standardized criteria should be developed for documenting CE findings, as well as for training and credentialing. More information is needed on the extent of bowel preparation that should be recommended for CE, and on the role of CE in patients with CD recurrence after surgery, those with polyposis syndromes, and patients with

Summary

These guidelines present recommendations for the use of small-bowel CE and CCE in the context of CD, celiac disease, and gastrointestinal bleeding. These 21 statements on the use of small-bowel CE and CCE also include recommendations pertaining to training, reporting, and informed consent.

The quality of evidence supporting these consensus statements was often very low owing to high risk of bias, indirectness, and imprecision. However, in many cases strong recommendations were made based on

Acknowledgments

The consensus group would like to thank Pauline Lavigne and Steven Portelance (unaffiliated), who provided medical writing services on their behalf, supported by funds from the Canadian Association of Gastroenterology.

The CAG would like to thank Allergan, Covidien, and Olympus for their generous support of the guideline process. The consensus group would like to thank the following people for their contributions: Paul Sinclair and Lesley Marshall (CAG representatives, administrative and

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    Conflicts of interest These authors disclose the following: Charles Bernstein has performed consulting for Mylan Pharmaceuticals, has served on the advisory board for AbbVie, Janssen, Pfizer, and Takeda, has received research or educational grants/clinical trial funding from AbbVie, Janssen, Shire, and Takeda, and has served on the speaker’s bureau for AbbVie and Shire; David Armstrong has served on the advisory board for AbbVie, Allergan, Janssen, Pfizer, and Lupin, has received research or educational grants/clinical trial funding from AbbVie, and has served on the speaker’s bureau for AbbVie, Allergan, Mylan, Pendopharm, Pentax, Pfizer, Shire, and Takeda; Robert A. Enns has served on the speaker’s bureau for AbbVie, Actavis, Boston Medical, Conmed, Cook, Covidien, Ferring, Gilead, Janssen, Merck, Olympus, Pendopharm, Pentax, Roche, Shire, Takeda, and Vantage; and Lawrence Hookey has received research or educational grants/clinical trial funding from Given Imaging, and served on the speaker’s bureau for Ferring. The remaining authors disclose no conflicts.

    Funding This guideline was supported through unrestricted grants to the Canadian Association of Gastroenterology by Allergan Canada, Covidien Canada ULC, a Medtronic company, and Olympus Canada Inc. who had no involvement in any aspect of the guideline development.

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