TABLE 4

Canadian Association of Gastroenterology consensus recommendations for and against capsule endoscopy^{^a}

For gastrointestinal bleeding, capsule endoscopy is recommended:

In patients with documented overt gastrointestinal (GI) bleeding (excluding hematemesis and negative findings on high-quality upper-GI endoscopy and colonoscopy)

As soon as possible in patients with an overt, obscure bleeding episode

Possibly as part of a repeat study (with endoscopy or colonoscopy) in patients with previous negative capsule endoscopy results who continue to have obscure bleeding

In selected patients with suspected obscure GI bleeding and unexplained mild chronic iron-deficiency anemia

For celiac disease, capsule endoscopy is recommended:

In patients with unexplained symptoms despite treatment and appropriate investigations

… But capsule endoscopy is discouraged:

To make a diagnosis in patients with suspected celiac disease

For Crohn disease, capsule endoscopy is recommended:

In patients presenting with clinical features consistent with Crohn disease and negative ileocolonoscopy and imaging studies

In patients with Crohn disease and clinical features unexplained by ileocolonoscopy or imaging studies

In patients with Crohn disease, when the assessment of small-bowel mucosal healing (beyond the reach of ileocolonoscopy) is needed (conditional recommendation)

In patients with a suspected small-bowel recurrence of Crohn disease after colectomy, undiagnosed by ileocolonoscopy or imaging studies

For polyposis, capsule endoscopy is recommended:

For ongoing surveillance in patients with polyposis syndromes who require small-bowel studies (conditional recommendation)

For colon studies, capsule endoscopy is discouraged:

As a routine substitute for colonoscopy

As a substitute for colonoscopy in patients with inflammatory bowel disease to assess the extent and severity of the disease

↵a The strength of these recommendations is strong, except for the 2 conditional recommendations noted. However, the quality of evidence is low or very low for all.
Based on information in reference 6.