Normal Findings and Landmarks in Capsule Endoscopy

Introduction

Capsule endoscopy offers a non-invasive method for visualizing the gastrointestinal (GI) tract, particularly beneficial for patients without dysphasia, allowing for easy ingestion of the capsule. However, in patients suffering from dysphasia, careful evaluation is necessary to determine suitability for the procedure.

During the examination, the esophageal junction is usually briefly observed, providing a glimpse of this critical anatomical landmark. It’s essential to report any pathology, especially if it is well demarcated, as these findings might require follow-up investigations, such as an Esophagogastroduodenoscopy (EGD). While capsule endoscopy does provide valuable insights, it does not replace the need for conventional upper GI tract examinations via flexible EGD, as the gastric mucosa is often incompletely visualized with the capsule.

As the capsule progresses past the pylorus, it typically moves swiftly through the duodenum, including the duodenal bulb and descending duodenum. One of the noteworthy structures, the papilla of Vater, may be obscured by luminal contents, like bile, and could potentially be overlooked in a rapid transit through the duodenum. In comparison, colon capsule endoscopy might offer advantages such as dual camera heads which increase the likelihood of consistently detecting the papilla of Vater, often visualized in the 8 o’clock position in related footage, complete with its opening and closing functionalities.

The normal small bowel mucosa should present with an intact villous architecture, clearly visualized through capsule endoscopy. As the capsule proceeds toward the mid and lower sections of the small intestine, observers may notice that villi become shorter, with the potential visibility of mucosal or submucosal blood vessels, which appear physiologically normal. It is important to note that there is no distinct endoscopic delineation between the jejunum and ileum. Practically, however, the small bowel is typically classified into upper, middle, and lower thirds, with capsule passage time providing a handy reference for delineation.

It is common to observe hyperplasia of lymphoid follicles in the terminal ileum, which does not suggest any pathological changes. The transition to the cecum can be recognized through changes in the mucosal appearance and the absence of villi, indicating passage through the valve of Bauhin.

The appendiceal orifice and the valve of Bauhin are more effectively visualized using a bi-directional colon capsule endoscope, enhancing diagnostic accuracy. In related visuals, the valve of Bauhin may be discerned at around the 8 o’clock position and should not be confused with polyps.

Keywords

• Capsule Endoscopy
• Dysphasia
• Esophageal Junction
• Esophagogastroduodenoscopy (EGD)
• Pylorus
• Duodenum
• Papilla of Vater
• Small Bowel Mucosa
• Villous Architecture
• Terminal Ileum
• Cecum
• Valve of Bauhin
• Appendiceal Orifice

FAQ

1. What is capsule endoscopy?
Capsule endoscopy is a non-invasive procedure that uses a small capsule with a camera to visualize the GI tract for diagnostic purposes.

2. Who is a suitable candidate for capsule endoscopy?
Patients without dysphasia can typically ingest the capsule easily. In patients with dysphasia, a critical appraisal of suitability is needed.

3. What landmarks can be observed during capsule endoscopy?
The esophageal junction, papilla of Vater, and areas of the small intestine such as the jejunum and ileum can be observed.

4. Can capsule endoscopy replace traditional endoscopic procedures?
No, capsule endoscopy does not substitute for thorough examinations like the flexible Esophagogastroduodenoscopy (EGD), as significant portions of the gastric mucosa might not be visualized.

5. What are common findings in the small bowel during capsule endoscopy?
Normal findings include intact villous architecture and physiological visibility of mucosal and submucosal blood vessels. Hyperplasia of lymphoid follicles in the terminal ileum is also common and typically non-pathological.