Professional Statements and Societal Positions Guidelines
The American College of Gastroenterology (ACG) - 2013
The ACG (2013) issued guidelines on the diagnosis and management of celiac disease. The guidelines recommended that capsule endoscopy (CE) not be used for initial diagnosis, except for individuals with positive celiac-specific serology who are unwilling or unable to undergo upper endoscopy with biopsy.
CE should be considered for the evaluation of small bowel mucosa in individuals with complicated Crohn disease.
The ACG (2018) updated its guidelines on the management of CD in adults. It makes two recommendations specific to video capsule endoscopy:
- 'Video capsule endoscopy (VCE) is a useful adjunct in the diagnosis of individuals with small bowel Crohn's disease in individuals in whom there is a high index of suspicion of disease.'
- 'Individuals with obstructive symptoms should have small bowel imaging and/or patency capsule evaluation before VCE to decrease risk of capsule retention.'
These recommendations are based on multiple studies. Capsule endoscopy was found to be 'superior to small bowel barium studies, computed tomography enterography (CTE) and ileocolonoscopy in individuals with suspected CD, with incremental yield of diagnosis of 32%, 47%, and 22%, respectively….Capsule endoscopy has a high negative predictive value of 96%.'
'However, some studies have questioned the specificity of capsule endoscopy findings for CD, and to date there is no consensus as to exactly which capsule endoscopy findings constitute a diagnosis of CD.'
The ACG (2015) issued guidelines on the diagnosis and management of small bowel bleeding (including using 'small bowel bleeding' to replace 'obscure GI [gastrointestinal] bleeding,' which should be reserved for individuals in whom a source of bleeding cannot be identified anywhere in the GI tract).
