Mistakes in capsule endoscopy and how to avoid them

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Mistakes in capsule endoscopy and how to avoid them

Reena Sidhu, Cristina Carretero

Summary

AI Generated

Capsule endoscopy is a noninvasive technique using a swallowable wireless camera to visualize the gastrointestinal mucosa of the small bowel and/or colon.

The small-bowel capsule has one optical dome and is generally used in patients with suspected bleeding or to identify evidence of active Crohn's disease.
The colon capsule has two optical domes and a higher frame rate, and can be considered as an alternative to conventional colonoscopy, especially when the examination was incomplete.
A new capsule with two optical domes is designed for panendoscopic study of both the small bowel and colon.
The capsule design differs depending on the part of the gastrointestinal tract to be studied.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Koulaouzidis A, Plevris JN. Detection of the ampulla of Vater in small bowel capsule endoscopy: Experience with two different systems. J Dig Dis 2012; 13: 621–627.

Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352–386.

Maiden L, Thjodleifsson B, Seigal A, et al. Long-Term Effects of Nonsteroidal Anti-Inflammatory Drugs and Cyclooxygenase-2 Selective Agents on the Small Bowel: A Cross- Sectional Capsule Enteroscopy Study. Clin Gastroenterol Hepatol 2007; 5: 1040–1045.

Sidhu R, Brunt LK, Morley SR, et al. Undisclosed use of nonsteroidal anti-inflammatory drugs may underlie small-bowel injury observed by capsule endoscopy. Clin Gastroenterol Hepatol 2010; 8: 992–995.

Liao Z, Gao R, Xu C, et al. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc 2010; 71: 280–286.

Rondonotti E, Koulaouzidis A, Karargyris A, et al. Utility of 3-dimensional image reconstruction in the diagnosis of small-bowel masses in capsule endoscopy (with video). Gastrointest Endosc 2014; 80: 642–651.

Shyung L-R, Lin S-C, Shih S-C, et al. Proposed Scoring System to Determine Small Bowel Mass Lesions Using Capsule Endoscopy. J Formos Med Assoc 2009; 108: 533–538.

Girelli CM, Porta P, Colombo E, et al. Development of a novel index to discriminate bulge from mass on small-bowel capsule endoscopy. Gastrointest Endosc 2011; 74: 1067–1074.

Rodrigues JP, Pinho R, Rodrigues A, et al. Validation of SPICE, a method of differentiating small bowel submucosal lesions from innocent bulges on capsule endoscopy. Rev Esp Enfermedades Dig 2017; 109: 106–113.

10.

Yung DE, Koulaouzidis A, Avni T, et al. Clinical outcomes of negative small-bowel capsule endoscopy for small-bowel bleeding: a systematic review and meta-analysis. Gastrointestinal Endoscopy 2017; 85: 305-317.e2.

11.

Eliakim R, Yassin K, Niv Y, et al. Prospective multicenter performance evaluation of the second-generation colon capsule compared with colonoscopy. Endoscopy 2009; 41: 1026–1031.

12.

Van Gossum A, Munoz-Navas M, Fernandez-Urien I, et al. Capsule endoscopy versus colonoscopy for the detection of polyps and cancer. N Engl J Med 2009; 361: 264–270.

13.

Spada C, Hassan C, Munoz-Navas M, et al. Second-generation colon capsule endoscopy compared with colonoscopy. Gastrointest Endosc 2011; 74: 581-589.e1.

14.

Spada C, Hassan C, Galmiche JP, et al. Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2012; 44: 527–536.

15.

Emanuele Rondonotti, Cristiano Spada, Samuel Adler, Andrea May EJD, Anastasios Koulaouzidis, Simon Panter, Dirk Domagk, Ignacio Fernandez-Urien GR, Maria Elena Riccioni, Jeanin E. van Hooft, Cesare Hassan MP. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2018; 50: 423–446.

16.

Nemeth A, Kopylov U, Koulaouzidis A, et al. Use of patency capsule in patients with established Crohn’s disease. Endoscopy 2016; 48: 373–379.

Abstract

Capsule endoscopy is a noninvasive technique intended for studying the small bowel and/or colon. The capsule endoscope consists of a small, wireless, pill-sized camera that can be swallowed and allows direct visualization of the gastrointestinal mucosa. The design of the capsule differs depending on the part of the gastrointestinal tract to be studied. The small-bowel capsule has one optical dome and is generally used in patients who have suspected bleeding or to identify evidence of active Crohn’s disease. By contrast, the colon capsule has two optical domes, a higher frame rate and can be considered as an alternative to conventional colonoscopy, especially for cases when the examination was incomplete. There is also a new capsule with two optical domes that is designed for the panendoscopic study of both the small bowel and colon.

Topics

Endoscopy

Citation

Carretero C and Sidhu R. Mistakes in capsule endoscopy and how to avoid them. UEG Education 2018; 18: 21-23.

Published

2024

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UEG Mistakes In Articles

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Mistakes in the evaluation and management of dysphagia and how to avoid them

Amir Mari, Edoardo Vincenzo Savarino, Jawad Hindy

Summary

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Summary is not available for this content yet.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Koulaouzidis A, Plevris JN. Detection of the ampulla of Vater in small bowel capsule endoscopy: Experience with two different systems. J Dig Dis 2012; 13: 621–627.

Liao Z, Gao R, Xu C, et al. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc 2010; 71: 280–286.

Shyung L-R, Lin S-C, Shih S-C, et al. Proposed Scoring System to Determine Small Bowel Mass Lesions Using Capsule Endoscopy. J Formos Med Assoc 2009; 108: 533–538.

Girelli CM, Porta P, Colombo E, et al. Development of a novel index to discriminate bulge from mass on small-bowel capsule endoscopy. Gastrointest Endosc 2011; 74: 1067–1074.

10.

11.

Eliakim R, Yassin K, Niv Y, et al. Prospective multicenter performance evaluation of the second-generation colon capsule compared with colonoscopy. Endoscopy 2009; 41: 1026–1031.

12.

Van Gossum A, Munoz-Navas M, Fernandez-Urien I, et al. Capsule endoscopy versus colonoscopy for the detection of polyps and cancer. N Engl J Med 2009; 361: 264–270.

13.

Spada C, Hassan C, Munoz-Navas M, et al. Second-generation colon capsule endoscopy compared with colonoscopy. Gastrointest Endosc 2011; 74: 581-589.e1.

14.

Spada C, Hassan C, Galmiche JP, et al. Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2012; 44: 527–536.

15.

16.

Nemeth A, Kopylov U, Koulaouzidis A, et al. Use of patency capsule in patients with established Crohn’s disease. Endoscopy 2016; 48: 373–379.

Abstract

Dysphagia is a common symptom with a broad differential diagnosis encompassing structural, inflammatory, infectious, functional, neurological, and oesophageal motility disorders. Despite major advances in endoscopy, high-resolution manometry (HRM), impedance planimetry (EndoFLIP), and swallowing assessment, diagnostic delays and inappropriate management remain common. In most cases, these shortcomings reflect errors in clinical reasoning rather than limitations of available investigations.¹

Increasing recognition of eosinophilic oesophagitis (EoE), functional dysphagia, opioid-induced oesophageal dysfunction, and complex motility disorders has further emphasised the importance of integrating clinical history with endoscopic, histological, physiological, and complementary radiological findings. Optimal evaluation increasingly requires multidisciplinary collaboration involving gastroenterologists, otolaryngologists, neurologists, speech–language pathologists, radiologists, and surgeons.¹^–⁵

In this article, we discuss the most common mistakes in the evaluation and management of dysphagia and provide practical, evidence-based recommendations to help clinicians avoid them.

Topics

Neurogastroenterology & Motility

Published

2026

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UEG Standards and Guidelines

Clinical Practice Guideline

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The European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer: Methodological Protocol

Laura Leeuwenburgh

Summary

AI Generated

Summary is not available for this content yet.

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Guideline

ABSTRACT

Background

Pancreatic cancer remains one of the most lethal cancers despite extensive efforts and research conducted over the past decades. To effectuate groundbreaking improvements in pancreatic cancer treatment, interdisciplinary and international collaboration is essential. Evidence-based guidelines, including state-of-the-art evidence and expert opinion, are crucial to guide medical specialists, researchers, and patients, especially on issues where consensus is still lacking. This article describes the methodological protocol for the development of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer. The guideline aims to identify current knowledge gaps on pancreatic cancer management, develop questions based on these knowledge gaps, and answer these questions with evidence-based recommendations supplemented, when evidence is lacking, with expert advice for treatment and future research.

Methods

This guideline development protocol is developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The process is structured into six stages: First, 13 theme-based multidisciplinary working groups are established, comprising representatives from 30 European medical and patient societies. Second, these working groups identify the most relevant current knowledge gaps on pancreatic cancer within their theme and formulate key questions. Third, the available evidence to answer these key questions is obtained through systematic reviews and the certainty of evidence is assessed using the GRADE approach. Fourth, recommendations are developed based on the available evidence. Fifth, all participants reach consensus on the recommendations through a modified Delphi process. Sixth, the recommendations are discussed during an open conference, including an external validation committee.

Discussion

This methodological protocol of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer is designed to identify key knowledge gaps across 13 themes and formulate evidence-based recommendations. This guideline initiative unites 30 European medical and patient societies for pancreatic cancer.

Summary

Methodological protocol of an international multi-disciplinary guideline involving 30 European medical and patient societies.
This protocol highlights the six stages of the guideline development process, adhering to the key principles of the GRADE methodology, and thereby aims to maximise transparency and methodological quality.
With addressing knowledge gaps, this guideline will uncover areas with limited evidence. A priority rating for research needs, based on a survey, will be established, highlighting areas where future research is most warranted.

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

Clinical and Public Health Guidelines 3 (2026)

Published

2026

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Transcriptomic dive into microscopic colitis

Celia Escudero-Hernández, Ahsen Ustaoglu

Summary

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Abstract

Topics

IBD

Published

2024

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European Interdisciplinary Guidelines on Pain Management in Acute Pancreatitis: UEG, EPC, EDS, ESDO, EAGEN, ESPGHAN, ESGAR, and ESPCG Evidence-Based Recommendations

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Summary

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Guideline

ABSTRACT

Pain is often the presenting symptom of acute pancreatitis (AP) and has a prognostic significance, with poorly treated pain affecting patient outcomes. Despite this, there are currently no international recommendations for pain management in patients admitted with AP. This current guideline was developed following the United European Gastroenterology framework for the development of high-quality clinical guidelines. Nine working groups were formed to develop statements on pain management in AP from admission to discharge. After systematic literature reviews, the evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted using three rounds of Delphi method. The guidelines concluded that acute postoperative pain management guidelines are applicable for treating acute pain due to AP. The numerical rating scale is preferred for pain assessment because of better compliance. Opioids currently form the cornerstone of severe pain management. Potent opioids such as buprenorphine and pentazocine provide superior pain relief over non-opioid medications and decrease the need for rescue analgesia. Current evidence does not consistently demonstrate harm from opioids in AP. In patients with severe pain, safety concerns should not delay the timely use of opioids to ensure adequate pain management. Specific recommendations concerning the use of epidural analgesia, acupuncture and management of pain in the paediatric population and during pregnancy are provided based on evidence and expert opinions. Finally, the unmet needs for future research were discussed and proposed.

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

United European Gastroenterology Journal, 2026

Published

2026

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Abstract

Topics

Stomach & H. Pylori

Published

2025

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UEG Mistakes In Articles

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Mistakes in abdominal distension and how to avoid them

Elizabeth Barba Orozco, Alberto Ezquerra-Durán

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Koulaouzidis A, Plevris JN. Detection of the ampulla of Vater in small bowel capsule endoscopy: Experience with two different systems. J Dig Dis 2012; 13: 621–627.

Liao Z, Gao R, Xu C, et al. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc 2010; 71: 280–286.

Shyung L-R, Lin S-C, Shih S-C, et al. Proposed Scoring System to Determine Small Bowel Mass Lesions Using Capsule Endoscopy. J Formos Med Assoc 2009; 108: 533–538.

Girelli CM, Porta P, Colombo E, et al. Development of a novel index to discriminate bulge from mass on small-bowel capsule endoscopy. Gastrointest Endosc 2011; 74: 1067–1074.

10.

11.

Eliakim R, Yassin K, Niv Y, et al. Prospective multicenter performance evaluation of the second-generation colon capsule compared with colonoscopy. Endoscopy 2009; 41: 1026–1031.

12.

Van Gossum A, Munoz-Navas M, Fernandez-Urien I, et al. Capsule endoscopy versus colonoscopy for the detection of polyps and cancer. N Engl J Med 2009; 361: 264–270.

13.

Spada C, Hassan C, Munoz-Navas M, et al. Second-generation colon capsule endoscopy compared with colonoscopy. Gastrointest Endosc 2011; 74: 581-589.e1.

14.

Spada C, Hassan C, Galmiche JP, et al. Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2012; 44: 527–536.

15.

16.

Nemeth A, Kopylov U, Koulaouzidis A, et al. Use of patency capsule in patients with established Crohn’s disease. Endoscopy 2016; 48: 373–379.

Abstract

Abdominal distension and bloating are among the most frequently misunderstood complaints in gastroenterology. They are often used as interchangeable terms, a conceptual mistake that continues to drive diagnostic errors and ineffective treatment. According to Rome IV, bloating and distension may represent either a primary disorder of gut–brain interaction (DGBI) or occur as symptoms with other DGBIs, such as irritable bowel syndrome (IBS), functional dyspepsia (FD) or functional constipation (FC).

Topics

Neurogastroenterology & Motility

Citation

Barba-Orozco E and Ezquerra-Durán A. Mistakes in abdominal distension and bloating and how to avoid them. UEG Education 2026; 26: 5-9.

Published

2026

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