Interestingly enough, other possible complications – which were postulated at the time of CE introduction (i.e., retention inside colonic diverticula, interaction with pacemakers, etc.) to represent potential hurdles for the method, were shown to be very infrequent and/or without clinically relevant consequences[67-71]. selleckbio Conversely, capsule aspiration – an unexpected complication – has been reported with increasing frequency (Table (Table66)[72-93]. Overall, this is probably related to the increase in the mean age of patients undergoing CE. In fact, capsule aspiration occurs in 1 out of 800-1000 procedures[88], mostly in elderly male patients with co-morbidities and/or swallowing disorders. In the majority of cases capsule aspiration resolves quickly, because patients expectorate the capsule.

However, in selected cases, emergency bronchoscopy is required. Thus far, only one fatality-directly associated with capsule aspiration- has been reported[90]. Table 6 Case reports of aspiration of capsule endoscopes CAN WE SHORTEN OUR READING TIME IN CAPSULE ENDOSCOPY? Few will disagree with the notion that CE is a time-consuming procedure. In fact, although capsule administration and swallowing requires only a couple of minutes, SBCE transit through the small bowel, although variable, on overage lasts about 2-5 h[94]. This results in 14400-72000 frames, depending on capsule frame rate (Table (Table1).1). This large amount of visual information requires careful evaluation by the CE reader. In addition, any small-bowel lesion may only be visible in just a few or even in a single frame[95].

Therefore, focused and undivided attention is required for the entire duration of each CE video evaluation. In light of all that, several attempts have been made to develop technical software features, in order to make CE video analysis easier and shorter (without jeopardising its accuracy). The first software feature designed for this purpose was the Suspected Blood Indicator (SBI), an automatic system able to pick up, in a completely automatic fashion, frames containing several red pixels and, therefore (theoretically), to detect blood and or other red-coloured lesions. Nevertheless, the accuracy profile of this tool (Table (Table7)7) is suboptimal and, at present time[96-102], it can be used only as supportive tool[102].

Table 7 Studies looking at the clinical validity of Suspected Blood Indicator, feature of capsule endoscopy reading software, in small-bowel capsule endoscopy Given?Imaging Ltd. has also introduced another software tool, which aims specifically at shortening the CE reading time, the AV-951 QuickView. This sampling tool is able to select one frame every X CE frames (the sampling rate can be set by the reader) and therefore present, with the click of a tag-button, a shortened CE video which can be reviewed in a few minutes.