Video Capsule Endoscopy: What Is the Future?

Video capsule endoscopy (VCE) that was launched 10 years ago has become a first-line procedure for examining the small bowel, especially in the case of obscure gastrointestinal bleeding. Other major indications include Crohn disease (CD), celiac disease, and intestinal polyposis syndrome. In the case of small bowel diseases, the use of VCE must be integrated in a global diagnostic and therapeutic approach. More recently, wireless endoscopy has been adapted for examining the colon, opening up larger perspectives for colorectal cancer screening or colon examination. Technologic modifications of the second-generation colon capsule increase the sensitivity of this method for detecting polyps. Other new developments, including remote magnetic manipulation, power management, drug delivery capsule, microbiopsy capsule, and adaptation of technologies such as chromoendoscopy, are sure to enhance the capabilities of wireless endoscopy in gastrointestinal disorders.

The introduction of wireless or video capsule endoscopy (VCE) has revolutionized imaging modalities in gastroenterology. In the last 10 years, the number of scientific publications on VCE has continuously increased, promoting a new interest for small bowel (SB) diseases. Initially, VCE was used to examine the SB but was rapidly considered as a first-line procedure for several intestinal disorders. Now, the procedure is largely used in clinical practice globally. Subsequently, VCE was adapted for examining the esophagus and, more recently, the colon. A new era of research and development is open. Indeed, many people believe that wireless endoscopy is still an incompletely developed technology. In this article, the authors focus on the use of VCE for SB and colon diseases and describe the new and potential capabilities of VCE.

Small bowel video capsule endoscopy

The VCE system comprises a capsule containing the video camera; a sensing system comprising an array of sensor pads, a data recorder, and a battery pack; and a workstation. A portable external viewer is also available for directly monitoring the images during the procedure. VCE was initially developed by Given Imaging (Yoqneam, Israel) for examining the SB (PillCam SB capsule). Subsequently, this company also developed the PillCam ESO capsule and the PillCam colon capsule for examining the esophagus and the colon, respectively. The small bowel video capsule endoscope (SBVCE) is 11 to 24–27.9 mm long, weighs approximately 3.4 to –6 g, and obtains 2 to 3 images per second. There are 5 capsule endoscopy systems available: PillCam (Given Imaging), EndoCapsule (Olympus, Center Valley, PA, USA), MiroCam (IntroMedic, Seoul, Korea), OMOM capsule (Jinshan Science and Technology, Chongqing, China), and Sayaka (RF SYSTEM lab, Nagano, Japan); however, only PillCam and EndoCapsule are currently approved by the Food and Drug Administration (FDA) for use in the United States. PillCam uses a complementary metal-oxide semiconductor (CMOS) chip, and the others use a charge-coupled device (CCD) chip for imaging ( Figs. 1–6 ).