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Small-Bowel Capsule Endoscopy and Device-Assisted Enteroscopy for Diagnosis and Treatment of Small Bowel Disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline
source: European Society of Gastrointestinal Endoscopy
authors: Marco Pennazio, Cristiano Spada, Rami Eliakim, Martin Keuchel, Andrea May, Chris J. Mulder, Emanuele Rondonotti, Samuel N. Adler, Joerg Albert, Peter Baltes, Federico Barbaro, Christophe Cellier, Jean Pierre Charton, Michel Delvaux, Edward J. Despott, Dirk Domagk, Amir Klein, Mark McAlindon, Bruno Rosa, Georgina Rowse, David S. Sanders, Jean Christophe Saurin, Reena Sidhu, Jean-Marc Dumonceau, Cesare Hassan, Ian M. Gralneksummary/abstract:
This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Guideline was also reviewed and endorsed by the British Society of Gastroenterology (BSG). It addresses the roles of small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders.
The field of gastrointestinal endoscopy has made great strides over the past several decades, and endoscopists have mastered the art of advancing flexible video endoscopes in the upper and lower parts of the gastrointestinal tract. Endoscopic evaluation of the small bowel (i. e., enteroscopy), on the other hand, poses a unique challenge that has plagued physicians for decades. With the development of newer enteroscopic modalities, a more thorough evaluation is now possible. These new techniques comprise small bowel video capsule endoscopy (VCE) and device-assisted enteroscopy; the latter includes double-balloon enteroscopy (DBE), single-balloon enteroscopy (SBE), spiral enteroscopy, and balloon-guided endoscopy (see Box 1). VCE has revolutionized small-bowel imaging by providing a reliable and noninvasive method for complete visualization and assessment of the mucosal surface. Given the increased detection of small-bowel disease by VCE, innovations in device-assisted enteroscopy have been crucial for histopathological confirmation, enabling endoscopic therapy in selected cases and thus avoiding the need for surgery. With these recent technological advances, enteroscopy currently has a pivotal role in the evaluation of patients with suspected small-bowel diseases, including obscure gastrointestinal bleeding (OGIB), iron-deficiency anaemia, suspected and known Crohn’s disease, tumours, polyposis syndromes, and coeliac disease. This Guideline, commissioned by the European Society of Gastrointestinal Endoscopy (ESGE) and endorsed by the British Society of Gastroenterology (BSG), in addition to updating previous ESGE guidelines [1, 2], analyzes in detail the performance of VCE and device-assisted enteroscopy compared with nonendoscopic methods for the investigation of the small bowel. The aim of this evidence-based and consensus-based Guideline, is to provide caregivers with a comprehensive guide for the clinical application of enteroscopy.
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