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Page 4 of 21 Tsuboi et al. Mini-invasive Surg 2024;8:26 https://dx.doi.org/10.20517/2574-1225.2023.94

Consequently, SBCE can directly affect the quality of the examination due to decreased visibility of the
mucosa. Meta-analyses have concluded that consuming 2 L of polyethylene glycol (PEG) solution before
capsule ingestion enhances the visibility of the small-bowel mucosa [32-36] . Several meta-analyses have also
reported that the use of antifoam agents, such as simethicone, improves the visibility of the mucosa [37,38] .
Although current guidelines often recommend bowel preparation before SBCE [29,39] , a standardized protocol
has not yet been established. In a recent meta-analysis, Marmo et al. revealed that the earlier the ingestion of
SBCE capsule following the administration of laxatives, the better the visualization of the mucosa .
[40]
Furthermore, there have been reports in recent years indicating that laxatives taken immediately prior to
examination lead to improved mucosal visibility [41,42] . Conversely, Lamba et al. reported that the
administration of laxatives before SBCE does not improve the diagnostic rate or visibility and leads to
[43]
decreased patient acceptability. Thus, further studies are needed to establish a pretreatment regimen .
For the completeness of the SBCE, a recent meta-analysis reported an observability rate of 87.6% for the
[11]
entire small-bowel mucosa . Westerhof et al. identified a history of small-bowel surgery, hospitalization,
moderate or poor bowel cleansing, and a gastric transit time of > 45 min as independent risk factors for
incomplete SBCE procedures . Diabetes mellitus has also been reported to be related to incomplete
[44]
SBCE . Factors contributing to prolonged gastric transit time of SBCE include hospitalization, diabetes
[45]
mellitus, cerebrovascular disease, older age, female sex, the use of psychotropic medications, and glucagon-
like peptide-1 receptor agonists [46-48] . The usefulness of image confirmation with a real-time viewer for
completing the SBCE examination has been reported . Additionally, the endoscopic SBCE delivery
[49]
[50]
method for patients with prolonged gastric transit time is useful for achieving complete SBCE .
From a safety perspective, the most common adverse event associated with SBCE is retention. Capsule
[9]
retention is defined as a capsule remaining in the gastrointestinal tract for more than two weeks . The
incidence of SBCE retention has been reported to be 1.2% to 4.6% . Consequently, SBCE can be
[51]
[9]
employed for safe and comprehensive small-bowel observation and is recommended as the preferred
modality for enteroscopy according to European, American, and Japanese guidelines . However, it is
[2-4]
important to note that the retention rate is higher for patients with Crohn’s disease. In a recent meta-
analysis on capsule retention in patients with Crohn’s disease, Pasha et al. reported retention rates of 4.63%
for cases with established Crohn’s disease and 2.32% for those with suspected Crohn’s disease . Therefore,
[51]
evaluating the presence of gastrointestinal strictures in advance, especially with a patency capsule, is
recommended for patients with Crohn’s disease.

When capsule retention occurs without symptoms, medical treatment is prioritized. With conservative
management, 10%-70% of capsules are naturally excreted [52-54] . If excretion does not occur, retrieval using
[55]
DAE may be required, with oral insertion being an effective approach in such cases .

To ensure the quality of SBCE, it is essential to fully understand its indications, contraindications, safety
profiles, and preparation regimens. Leighton et al. reported quality indicators for SBCE and DAE . It is
[56]
hoped that implementing these quality indicators in clinical practice will enhance the quality of
examinations at each institution.

CURRENT STATUS OF SBCE DEVICES
A variety of SBCE devices are available, as listed in Supplementary Table 1. One notable device is the
PillCam SB, developed by Given Image , which has evolved into its third generation known as PillCam
TM
TM
[5]
SB3, measuring 26.2 mm in length and 11.4 mm in width. The first-generation PillCam captures two
TM
TM
pictures per second with a 140° field of view. In contrast, the second-generation PillCam offers a wider