Video capsule endoscopy (VCE) is an established approach for small bowel examination. In 2022, the European Society of Gastrointestinal Endoscopy (ESGE) published an updated guideline on VCE use. However, little is known about the implementation of these guidelines in daily clinical practice in Germany.

Between June and August 2025 we conducted a nationwide online-based survey on the use of VCE in Germany. An online questionnaire was distributed via a web link to members of “The German Society for Gastroenterology, Digestive and Metabolic Disease” (DGVS), the “Association of Practicing Gastroenterologists” (BNG) and senior physicians working in gastroenterology departments at academic teaching hospitals in Germany. A total of 234 accessed the survey of which 171 were included in the final analysis. The survey included topics related to the performance of capsule endoscopy, the implementation of ESGE guidelines and reimbursement.

The most common indications for VCE were suspected small bowel bleeding (91.2 %) and iron deficiency anaemia (86.2 %). VCE was rarely used for visualisation of the colon (5.0 %). In 2024, most clinicians (48.2%) performed 10 to 30 VCE procedures. The PillCam system (88.2 %) was by far the most common used VCE system.

99.4% of the asked clinicians performed bowel preparation before VCE use and reported good to very good (93.7%) mucosal visualisation in the majority of their patients. The interpretation of VCE studies was described as time-intensive with generally requiring 31 to 45 minutes per case (34.8%). 34.2% spent 46 to 60 minutes or longer for analysing the examination. The implementation of validated scoring systems such as the Lewis Score for Crohn’s disease (9.7%) and the Saurin classification for bleeding lesions (5.1 %) was infrequent.

51.9 % of the participants are not familiar with the ESGE guideline from 2022.

In patients with suspected small bowel bleeding VCE is performed within 48 hours after onset by 63.2 % of the participants.

The reported capsule retention rate was high: 24,5 % (39/159) had at least one retention in 2024. Patency capsules were infrequently used in patients with suspected or known Crohn’s disease.

Overall, participants regarded VCE as a valuable diagnostic tool; however, reimbursement was widely perceived as inadequate.

This first nationwide study evaluated the use of VCE in Germany, revealing that VCE is a valuable and specialised diagnostic tool, with most procedures for suspected small-bowel bleeding conducted within 48 hours of bleeding onset.

Interpretation remains time-consuming and reimbursement is widely viewed as inadequate. Among specialised gastroenterologists who routinely perform VCE, knowledge of the ESGE VCE guideline is limited.