Capsule endoscopy presents a significantly greater diagnostic yield than other conventional procedures for the diagnosis of small bowel disease. The results suggest that CE might also be superior to double balloon enteroscopy but the studies are of low quality. Detection rates seem to be higher for patients with visible bleeding and for patients with more severe disease (lower hemoglobin levels, greater number of transfusions) and longer symptomatology. The diagnostic yields obtained seem to depend however on the criteria used to classify subjects and present higher values when insignificant or suspicious lesions are included as positive results than when only relevant lesions are considered.
The real effectiveness of CE is still unclear. The results on sensitivity, specificity, positive and negative predictive values are very heterogeneous and are mainly based on arbitrary classifications. One study verified all the results with the reference standard (intraoperatory enteroscopy) but the results might be exaggerated since suspicious lesions were considered.
The impact of CE on patient management and clinical outcomes is unknown. The results are heterogeneous and discrepant in some cases. There are doubts as to the relevance of some of the lesions diagnosed. With the available information it is not clear that CE should be used as a first line diagnostic tool. The precise role of CE in the diagnostic algorithm has to be determined with adequately designed prospective studies with longer follow up periods.
