Small-bowel endoscopy.

The role of small-bowel endoscopy in the management of small-bowel diseases is still evolving. During the last year, capsule endoscopy has developed from being an emerging method in gastroenterology to become a clinical reality, and it must now be considered critically. A number of peer-reviewed studies have been published that compare the method with push enteroscopy in patients with obscure gastrointestinal bleeding. In other studies, capsule endoscopy has been compared with traditional radiographic methods of examining the small bowel. The potential of capsule endoscopy for diagnosing small-bowel diseases has also been evaluated, particularly in patients with suspected Crohn's disease. Although this innovative diagnostic method has now entered clinical practice, it must be stressed that both push enteroscopy and intraoperative enteroscopy still have a precise and valid role in the management of patients with small-bowel diseases, as may be seen from several of the studies that are reviewed here. Capsule endoscopy will probably become a first-line tool for detecting abnormalities of the small bowel, and very probably this will entail redefining some diagnostic algorithms for diseases involving the small bowel. Nevertheless, further studies are required before today's clinical practice can be definitively modified, and these should make particular reference to the outcome in patients who undergo capsule endoscopy.