ASGE Masterclass: Capsule Quest – Journey Through the Future of GI Diagnostics (Virtual) | March 2025-Capsule Chronicles: When to Use and When to Lose It

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The document "Capsule Chronicles" by Iris L Vance, MD, examines the strategic application and limitations of capsule endoscopy, offering guidance on when to use this technology and when to consider alternatives. Capsule endoscopy is highlighted as a diagnostic tool primarily for specific conditions such as overt gastrointestinal bleeding, suspected or established small bowel Crohn’s disease, iron deficiency anemia under certain conditions, and polyposis syndromes (like FAP and PJS). It plays a complementary role alongside other radiologic techniques, allowing for more accurate assessments where traditional endoscopy or imaging may fall short.<br /><br />For GI bleeding, capsule endoscopy should follow after negative EGD and colonoscopy results, with timing playing a crucial role in diagnostic yield. Its effectiveness is evident in instances of clinically significant bleeding and specific conditions of iron deficiency anemia, primarily when traditional treatments and diagnostics are inconclusive.<br /><br />Capsule endoscopy is noted for its higher sensitivity compared to CT enterography in diagnosing Crohn's disease and is useful for monitoring mucosal healing and postoperative recurrence. However, it is not recommended for individuals with chronic abdominal pain or diarrhea lacking biomarker corroboration.<br /><br />In cases of polyposis syndromes, capsule endoscopy is recommended regularly, with intervals dependent on individual risk factors and findings, whereas in refractory celiac disease, it helps identify complications like lymphoma or small bowel adenocarcinoma.<br /><br />Key contraindications for capsule endoscopy include known bowel obstructions, significant swallowing difficulties, and the presence of certain cardiac devices, though recent studies have shown no interference with such devices. Alternatives like magnetic resonance enterography (MRE) or computed tomography enterography (CTE) are suggested when capsule endoscopy is contraindicated.<br /><br />Overall, this guide underscores the critical role of tailored patient assessments and timely interventions in the effective use of capsule endoscopy.

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Learning Objectives:
1. Discover the top reasons to choose capsule endoscopy for your patients.
2. Learn the red flags and how to manage patients who aren’t the best fit for the procedure.
3. Discuss how capsule endoscopy complements small bowel radiologic technologies

Keywords

capsule endoscopy

gastrointestinal bleeding

Crohn's disease

iron deficiency anemia

polyposis syndromes

diagnostic tool

radiologic techniques

contraindications

mucosal healing

alternative diagnostics