Résumé
L’intestin grêle reste, pour reprendre les expressions des auteurs américains, «la dernière frontière» [1], «le bout du tunnel» [2], du gastroentérologue. En effet, les différents moyens de l’explorer sont difficiles à mettre en œuvre pour plusieurs motifs: a) fragilité du matériel comme la sonde d’entéroscopie [3]; b) morbidité non négligeable comme l’entéroscopie chirurgicale [4], c) caractère incomplet de l’examen parce que limité aux premières anses jéjunales comme l’entéroscopie par voie haute ou aux dernières anses iléales pour l’iléoscopie rétrograde au cours d’une coloscopie [5]; d) évaluation insuffisante de l’entéroscopie par double ballon [6]. C’est dans ce contexte qu’est commercialisée la vidéo-capsule endoscopique (VCE) (Given Imaging LTD Yoqneam Israel) fruit du travail initial de 2 ingénieurs israéliens: Iddan et Meron [7]. Elle est actuellement mise à notre disposition ainsi que la station de traitement de l’image par la Firme Given Imaging® (Gastrointestinal Vidéoendoscopy). Son utilisation clinique est approuvée par la FDA depuis août 2001, le marquage CE est obtenu depuis mai 2002.
Nous vous proposons d’en rappeler les principes, d’exposer les développements technologiques disponibles, le déroulement de l’examen et de préciser les indications évaluées, en cours d’évaluation et les conditions de sécurité qui doivent l’accompagner, enfin les perspectives futures.
Summary
The endoscopic examination of the small bowel remains nowadays the « ultimate frontier » or the « black box » in gastroenterology, as stated by American authors [1,2].The various techniques allowing the examination of the small bowel are indeed difficult to undertake for various reasons: a) fragility of the device, as for probe enteroscopy [3],b) significant morbidity related to the procedure, as for peroperative enteroscopy [4],c) limited extent of the examination to the proximal jejunal loops for pushenteroscopy and to the distal ileum for retrograde ileoscopy [5],d) too preliminary experience with double balloon total enteroscopy [6].Therefore, the release of the endoscopic videocapsule (VCE) (Given Imaging Ltd, Yoqneam, Israel) has been regarded as a significant advance. The VCE was developed by two Israelian engineers: Iddan et Meron [7]and is now available in France. Its clinical use was approved by FDA in August 2001 and it was CE labelled in May 2002.
The aim of this review is to describe the principle and the possible technological advances of VCE, how the procedure is performed and define the indications, either validated or under evaluation. We shall end with some safety considerations and future developments.
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Delvaux, M., Fassler, I. & Gay, G. La vidéo-capsule endoscopique: état de l’art. Acta Endosc 34, 293–304 (2004). https://doi.org/10.1007/BF03004258
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DOI: https://doi.org/10.1007/BF03004258