Capsule Endoscopy: Ways to Avoid Missing Lesions and to Optimize Diagnostic Yield

Capsule endoscopy allows complete endoscopy of the small intestine, and its diagnostic yield can be increased with proper patient selection and preparation for the procedure. The use of prokinetic medications and bowel-cleansing solutions may be beneficial, but further studies are needed. Simethicone may decrease bubbles in the small intestine. Incomplete studies warrant further evaluation with complementary radiology studies, such as computed tomography enterography or magnetic resonance enterography, double-balloon enteroscopy, or a repeat capsule endoscopy. Patients with delayed gastric emptying should be considered for a repeat capsule endoscopy with the capsule being placed in the duodenum at the time of an upper gastrointestinal endoscopic examination. The yield of capsule endoscopy may be increased by spending more time examining the proximal small bowel and by utilizing the suspected blood indicator.