Background ?We aimed to document international practices in small-bowel capsule endoscopy (SBCE), measuring adherence to European Society of Gastrointestinal Endoscopy (ESGE) technical and clinical recommendations. Methods ?Participants reached through the ESGE contact list completed a 52-item web-based survey. Results ?217 responded from 47 countries (176 and 41, respectively, from countries with or without a national society affiliated to ESGE). Of respondents, 45?% had undergone formal SBCE training. Among SBCE procedures, 91?% were performed with an ESGE recommended indication, obscure gastrointestinal bleeding (OGIB), iron-deficiency anemia (IDA), and suspected/established Crohn's disease being the commonest and with higher rates of positive findings (49.4?%, 38.2?% and 53.5?%, respectively). A watchful waiting strategy after a negative SBCE for OGIB or IDA was preferred by 46.7?% and 70.3?%, respectively. SBCE was a second-line exam for evaluation of extent of new Crohn's disease for 62.2?% of respondents. Endoscopists adhered to varying extents to ESGE technical recommendations regarding bowel preparation (?>?60?%), use in those with pacemaker holders (62.5?%), patency capsule use (51.2?%), and use of a validated scale for bowel preparation assessment (13.3?%). Of the respondents, 67?% read and interpreted the exams themselves and 84?% classified exams findings as relevant or irrelevant. Two thirds anticipated future increase in SBCE demand. Inability to obtain tissue (78.3?%) and high cost (68.1?%) were regarded as the main limitations, and implementation of artificial intelligence as the top development priority (56.2?%). Conclusions ?To some extent, endoscopists follow ESGE guidelines on using SBCE in clinical practice. However, variations in practice have been identified, whose implications require further evaluation.