This chapter describes how to perform a typical small bowel video capsule endoscopy (SBCE) procedure, including principles of patient management throughout the procedure pathway and strategies to optimize study quality. Models of service delivery, particularly in the context of the COVID-19 pandemic, are also discussed. Patient management begins at the point of receipt of referral. Assessment of indications, contraindications and special considerations are necessary. An informed consent process should be undertaken before an SBCE procedure is performed. Patient information should include preparation requirements, the procedure and its benefits, and the level of risk associated with the procedure. The risk of capsule retention and the rare risk of aspiration must be discussed. Preparation of the bowel in advance of the procedure is important to ensure optimal cleanliness and image quality. A 12-h overnight fasting period combined with the use of bowel cleansing purgatives is recommended. Polyethylene glycol (PEG) is the most widely used. The optimal volume and timing have not yet been determined. Lower volume PEG (2 L) has been found to be effective and is advocated in international guidelines. A split dose evening/morning regimen appears to improve visualization of the distal ileum by flushing the bowel closer to the time of capsule ingestion. The administration of simethicone at the time of capsule ingestion is standard practice. The method of performing an SBCE procedure is broadly determined by the mode of data acquisition and storage. There are two types of small bowel capsules currently used; those that transmit images to an external data recorder worn by the patient and those that record and store data within the capsule itself. External data recording equipment requires manual assembly and prior check-in of patient details. Capsules with integral data storage require no accompanying recording equipment but must be retrieved following excretion in order to access the data. The use of real-time viewing is recommended to monitor capsule progression, detect delayed gastric transit and to identify aspiration of the capsule. Real-time viewing is not available for systems with integral data storage. Capsule endoscopy services are generally delivered within ambulatory out-patient settings or within hospital settings for in-patient procedures. Where patient access to services is restricted by geographical and travel challenges, and in pandemic scenarios, alternative approaches to service delivery may be adopted to enable procedures to be self-administered by patients at home. Patients should be carefully selected for home ingestion.

Procedure for Small Bowel Video Capsule Endoscopy

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发表日期：

2025年

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Carolyn Davison,
Amit Chattree

摘要

This chapter describes how to perform a typical small bowel video capsule endoscopy (SBCE) procedure, including principles of patient management throughout the procedure pathway and strategies to optimize study quality. Models of service delivery, particularly in the context of the COVID-19 pandemic, are also discussed. Patient management begins at the point of receipt of referral. Assessment of indications, contraindications and special considerations are necessary. An informed consent process should be undertaken before an SBCE procedure is performed. Patient information should include preparation requirements, the procedure and its benefits, and the level of risk associated with the procedure. The risk of capsule retention and the rare risk of aspiration must be discussed. Preparation of the bowel in advance of the procedure is important to ensure optimal cleanliness and image quality. A 12-h overnight fasting period combined with the use of bowel cleansing purgatives is recommended. Polyethylene glycol (PEG) is the most widely used. The optimal volume and timing have not yet been determined. Lower volume PEG (2 L) has been found to be effective and is advocated in international guidelines. A split dose evening/morning regimen appears to improve visualization of the distal ileum by flushing the bowel closer to the time of capsule ingestion. The administration of simethicone at the time of capsule ingestion is standard practice. The method of performing an SBCE procedure is broadly determined by the mode of data acquisition and storage. There are two types of small bowel capsules currently used; those that transmit images to an external data recorder worn by the patient and those that record and store data within the capsule itself. External data recording equipment requires manual assembly and prior check-in of patient details. Capsules with integral data storage require no accompanying recording equipment but must be retrieved following excretion in order to access the data. The use of real-time viewing is recommended to monitor capsule progression, detect delayed gastric transit and to identify aspiration of the capsule. Real-time viewing is not available for systems with integral data storage. Capsule endoscopy services are generally delivered within ambulatory out-patient settings or within hospital settings for in-patient procedures. Where patient access to services is restricted by geographical and travel challenges, and in pandemic scenarios, alternative approaches to service delivery may be adopted to enable procedures to be self-administered by patients at home. Patients should be carefully selected for home ingestion.