HOW TO INTERPRET CAPSULE ENDOSCOPY FOR THE SMALL BOWEL

Abstract

Regarding capsule endoscopy (CE), it is generally considered to be not so difficult technically to perform, but presents many problems in the interpretation of the results. In May 2011, two CE systems, the ‘PillCam SB’ by Given Imaging Co. and ‘Endo Capsule’ by Olympus Medical Co., were introduced into real clinical practice, and both are not so different regarding the method of examination.
The interpretation time, which was initially 60 to 90 minutes, has been shortened to 30 minutes due to the improvement of optional modalities. The software image interpretation programs of these CE devices have some different functions including options. We believe that the better interpretation can be managed by utilizing the original function and basing the image interpretation on our own style.
For the PillCam software, the optimum interpretation can be obtained based on three steps, preview, review and report. We believe that, for the preview step, the options of 10 times the speed and four visions are the best approach. In this way, each landmark should be checked, for example, the first gastric image or cecal image. For the review stage, we think 15 times the speed for two visions or 20-25 times the speed and four visions give the best results. We usually interpret in the manual mode, but change into the automatic mode when the capsule is stationary at the same part. Finally, we check all the thumbnails and complete the patient's report. As for the EndoCapsule, we suggest that the reader learns the method to utilize the functions of the overview, selected and skipped modes. In the near future, improved software will be introduced for the whole automatic diagnosis. Since CE is performed under physiological conditions without air supply, the CE findings are often different from those obtained by standard endoscopy for the same lesion. Diagnosis is requested whenever only a part of the lesion is shown in the images. Thus, to achieve an exact final diagnosis, it is important to practice the various cases, thus advancing the reading skills. CE interpretation requires training and getting new information. It is estimated that the experience of 10 cases and assessment by an expert are needed for standard CE interpretation.