Current Practices and Perspectives on Video Capsule Endoscopy in Germany: Findings from a nationwide survey of gastroenterologists.

BACKGROUND AND STUDY AIMS: Video capsule endoscopy (VCE) is an established approach for small bowel (SB) examination. In 2022, the European Society of Gastrointestinal Endoscopy (ESGE) updated its guideline on VCE use. However, little is known about guideline implementation in daily clinical practice. METHODS: Between June and August 2025, we performed a nationwide online survey on VCE use in Germany. A questionnaire was distributed to gastroenterologists in Germany performing VCE in in- or outpatient settings. RESULTS: The main indications for VCE were SB bleeding and iron deficiency anaemia. In 2024, most physicians (48.2%, 82/170) performed 10 to 30 VCE procedures, mainly using the Pillcam system. In patients with active SB bleeding VCE was performed promptly. For elective cases, the waiting time for VCE was typically no more than two weeks (86 %, 141/164). RESULTS: Nearly all participants (99.4%, 156/157) used laxatives for bowel preparation. VCE interpretation is time-intensive, with most participants (34.8%, 55/158) requiring 31 to 45 minutes per case. Overall, participants considered VCE to be a valuable diagnostic tool; however, reimbursement was widely perceived as inadequate. CONCLUSION: This first nationwide study on the use of VCE in Germany shows that VCE remains a niche diagnostic tool with relatively few procedures per centre. Despite time-intensive interpretation and perceived inadequate reimbursement waiting times are generally short.