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Imaging of Small Bowel Disease: Comparison of Capsule Endoscopy, Standard Endoscopy, Barium Examination, and CT¹

¹ From the Departments of Radiology (A.K.H.) and Gastroenterology (J.A.L., V.K.S., R.I.H., D.E.F.), Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259. Recipient of a Cum Laude award for an education exhibit at the 2003 RSNA Scientific Assembly. Received June 16, 2004; revision requested July 16 and received August 18; accepted August 20. All authors have no financial relationships to disclose. Address correspondence to A.K.H. (e-mail: hara.amy{at}mayo.edu).

Capsule endoscopy is a revolutionary new diagnostic tool for the detection of small bowel disease. As the name implies, capsule endoscopy makes use of a swallowable video capsule; as such, it is the only technique that allows noninvasive endoscopic examination of the entire small bowel without sedation. Obscure gastrointestinal bleeding is the most common indication for capsule endoscopy, which commonly depicts arteriovenous malformations, small bowel tumors, and ulcers missed at standard endoscopy and imaging examinations. However, capsule endoscopy is not optimal for the localization of small bowel lesions. In addition, lesions can be missed due to poor bowel preparation, rapid or delayed small bowel transit, or orientation of the camera away from a lesion. Computed tomography and barium examinations are useful for detecting these missed lesions and for localizing lesions detected at capsule endoscopy. Other limitations of capsule endoscopy are the inability to treat lesions and its limited use in patients with small bowel strictures or obstruction. Nevertheless, this new technique is easy to perform, is well tolerated by patients, and, for the first time, allows noninvasive endoscopic evaluation of the entire small bowel.

© RSNA, 2005

Abbreviations: EGD = esophagogastroduodenoscopic, FDA = Food and Drug Administration, NSAID = nonsteroidal anti-inflammatory drug

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