AIM: To review and summerize the current literatue regarding M2A wireless capsule endoscopy.

METHODS: Peer reviewed publications regarding the use of capsule endoscopy as well as our personal experience were reviewed.

RESULTS: Review of the literature clearly showed that capsule endoscopy was superior to enteroscopy, small bowel follow through and computerized tomography in patients with obscure gastrointestinal bleeding, iron deficiency anemia, or suspected Crohn’s disease. It was very sensitive for the diagnosis of small bowel tumors and for survailance of small bowel pathology in patients with Gardner syndrome or familial adenomatous polyposis syndrome. Its role in celiac disease and in patients with known Crohn’s disease was currently being investigated.

CONCLUSION: Capsule video endoscopy is a superior and more sensitive diagnostic tool than barium follow through, enteroscopy and entero- CT in establishing the diagnosis of many small bowel pathologies.

The M2A video capsule endoscope (CE) (Given Imaging LTd; Yokneam,Israel) is a wireless capsule (11 mm × 27 mm) comprised of a light source, lens, CMOS imager, battery and a wireless transmitter. The slippery out side coating of the capsule allows easy ingestion and prevents adhession of intestinal contents, while the capsule moves via peristalsis from mouth to anus. The battery provides 7-8 h of work in which the capsule photographs 2 images per second (between 50000-60000 images all together), which are transmitted to a recorder which is worn on the belt. The recorder is downloaded into a computer and seen as a continous video film. Since its development additional support systems have been added a localization system, a blood detector and a double picture viewer. All ment to assist the interpretor of the film and to shorten the reviewing period.

The full range of indications for CE became apperant with time. The initial device was invented to address a need for a better diagnostic tool for small bowel pathologies.

The only definite contraindication for CE was a patient with a history of intestinal obstruction or known stricture, or a patient who was a non surgical candidate.

Severe motility problems, or swallowing abnormalities could also preclude the use of CE. Initialy patients with pacemakers were excluded from CE trials, but recent data mostly in abstract form, revealed that CE could be safely performed in patients with pacemakers.

The major complication with CE was capsule retention or non natural excretion (NNE) which was usually proximal to a stricture. This happened many times despite normal small bowel X-rays. History of NSAID usage, ischemic bowel event or known Crohn’s disease, carried higher risk for NNE. NNE that neccesitated surgery occurred in less than 1% of all patients and in 1.25% of patients with Crohn’s disease[9]. Usually, there were no clinical signs or symptoms and NNE was found when doing a plain abdominal film. Retrieval of the capsule and ressection of narrowed segment via surgery, usually resolved the medical problem which was detected by the retained capsule.

M2A CE is a safe, valuable, non-invasive, innovative tool for the diagnosis and management of small bowel lesions like OGIB, Crohn’s disease, chronic diarrhea and probably other small bowel diseases.

Newer versions of CE softwear allow us to get better localization and blood detection. Advanced versions will allow us to get therapeutic modalities and a shorter reading time.