Capsule endoscopy in patients refusing conventional endoscopy

Capsule endoscopy is nowadays the diagnostic technique of choice in the study of small bowel pathologies, allowing the non-invasive study of the entire mucosa. This has led, together with new technical advances, to the creation of two new models (PillCam ESO and PillCam Colon) for the study of esophageal and colonic diseases. These two new capsules offer an interesting alternative to conventional endoscopy in the study of the upper and lower digestive tracts, because traditional endoscopy is often unpleasant and uncomfortable for the patient, can be painful, often requires moderate or deep sedation and is not without complications (hemorrhage, perforation, etc.). PillCam Colon is particularly important for its usefulness in the diagnosis of colonic polyps, and is a potentially useful tool in cases of incomplete colonoscopy or in colorectal cancer screening, even more when most patients are reluctant to undergo screening programs due to the said disadvantages of conventional colonoscopy. This article discusses the advantages of capsule endoscopy over conventional endoscopy, its current application possibilities and indications in routine clinical practice. In the various sections of the work, we assess the application of endoscopic capsule in different sections of the digestive tract (esophagus, stomach, and colon) and finally the potential role of panendoscopy with PillCam Colon.     

Capsule endoscopy--state of the art

Capsule endoscopy is a new technology that was recently introduced into clinical practice for the diagnosis of gastrointestinal diseases. As of today, three different capsule types have been produced, designed for the exploration of the small bowel (PillCam SB), the esophagus (PillCam ESO) and the colon (PillCam Colon). The PillCam SB has gained widespread acceptance as a powerful tool for the diagnosis of bleeding from the small bowel as well as for other indications. The PillCam ESO has been used to study patients with gastroesophageal reflux disease, for the screening of Barrett's esophagus, and for the screening and surveillance of esophageal varices in patients with cirrhosis. The results of the pilot studies carried out with this capsule have been encouraging. Large-scale studies are ongoing. The evaluation of the potential of the PillCam Colon capsule is still in its infancy: the two pilot studies published showed that this capsule can produce high-quality images of the colon. The potential of this capsule for clinical purposes, such as colon cancer screening, needs to be evaluated.     

Colon capsule endoscopy: What we know and what we would like to know

Colonoscopy is usually perceived as an invasive and potentially painful procedure,being also affected by a small,but definite,risk of major complications(cardiopulmonary complications,perforation,hemorrhage)and even mortality.To improve both acceptability and safety,Pill Cam Colon Capsule Endoscopy(CCE)(Given Imaging Ltd,Yoqneam,Israel)has been developed.CCE represents a non-invasive technique that is able to explore the colon without sedation and air insufflation.The Second Generation of Colon Capsule Endoscopy(Pill Cam Colon 2)(CCE-2)was proven to be an accurate tool to detect colonic neoplastic lesions when used in average risk individuals.To date,the evidence supports the use of CCE-2 in case of colonoscopy failure,in patients unwilling to perform colonoscopy and when colonoscopy is contraindicated.Other potential applications,such as colorectal cancer screening or diagnostic surveillance ofinflammatory bowel disease need to be clarified.In this paper,the current“state of the art”,potential application of CCE and future needs are evaluated.     

Colon capsule endoscopy: Current status and future directions

Colon capsule endoscopy(CCE; Pill Cam Colon; Given Imaging; Yoqneam, Israel) is a minimally invasive wireless technique for the visualization of the colon. With the recent introduction of the second generation colon capsule the diagnostic accuracy of CCE for polyp detection has significantly improved and preliminary data suggest it may be useful to monitor mucosal inflammation in patients with inflammatory bowel disease. Limitations include the inability to take biopsies and the procedural costs. However, given the potentially higher acceptance within an average risk colorectal cancer(CRC) screening population, its usefulness as a screening tool with regard to CRC prevention should be further evaluated.     

PillCam Colon 2 capsule in patients unable or unwilling to undergo colonoscopy

AIM: To assess the feasibility, accuracy and acceptability of PillCam Colon 2 in detection of significant lesions in colorectal cancer risk patients, unable or unwilling to perform colonoscopy.METHODS: This is a prospective, single center study using the second generation of PillCam Colon capsule. In all patients the readers were instructed to review the entire colon capsule endoscopy (CCE) examination using Rapid 7 software and additionally to note significant extra-colonic findings. Colonic significant findings were described according to European Society of Gastrointestinal Endoscopy guidelines. CCE procedure completion rate, level of bowel preparation and rate of adverse events were assessed.RESULTS: A total of 70 patients at risk of colorectal cancer were enrolled in the study. In three patients the procedure failed because the capsule was not functioning when entered the colon. PillCam Colon 2 showed positive findings in 23 (34%, 95%CI: 21.6%-44.1%) of the remaining 67 patients. Six patients were diagnosed with tumors: 4 with colon cancers, 1 with gastric cancer and 1 with a small bowel cancer. The capsule findings were confirmed after surgery in all these patients. The capsule excretion rate in twelve hours was 77% with 54 patients having a complete examination. The rectum was not explored during CCE procedure, in 16 patients (23%, 95%CI: 13.7%-34.1%). Every patient accepted CCE as an alternative exploration tool and 65/70 (93%) agreed to have another future control by CCE. No complications were reported during or after CCE examination.CONCLUSION: PillCam Colon 2 capsule was effective in detecting significant lesions and might be considered an adequate alternative diagnostic tool in patients unable or unwilling to undergo colonoscopy.     

Capsule endoscopy: a comprehensive review

The development of wireless capsule endoscopy (CE) has been a significant technologic advancement for the non-invasive visual evaluation of the entire small bowel and esophagus. The capsule endoscope is disposable and measures 11 x 26 mm. There are two capsule endoscopes currently available: PillCam ESO and PillCam SB for the evaluation of the esophagus and the small bowel, respectively. The PillCam ESO has two cameras on each end and captures images 7 frames per second per each camera, while the PillCam SB has one camera and captures images at a rate of 2 frames per second. Both capsule endoscopes transmit the image data using a radiofrequency signal to a recording device worn on the patient's waist. Once image acquisition is completed, the data from the recording device is downloaded to a computer workstation and analyzed by a gastroenterologist. Common indications for the small bowel CE include obscure gastrointestinal bleeding (OGIB), suspected Crohn disease (CD), as well as other suspected small bowel pathologies, while indications for the esophageal CE include screening of Barrett esophagus and esophageal varices. Small bowel CE appears to be more sensitive in the evaluation of OGIB and small bowel CD compared with other conventional radiological and endoscopic modalities. Preliminary results for the esophageal CE reveal good accuracy for screening of both Barrett and esophageal varices. CE is well tolerated by most patients, requires no sedation, and carries few side effects. One of the complications of CE is capsule retention; however, a patency capsule system has been developed, which can indicate whether an obstructing lesion is present before CE is performed. Finally, there are preliminary data suggesting that a new capsule endoscope for the colon may be useful in the evaluation of patients for colon polyps and possibly, screening for colon cancer.     

Capsule endoscopy compared with conventional colonoscopy for detection of colorectal neoplasms

Colon capsule endoscopy(CCE) may be a means to overcome the low adherence to colorectal cancer screening. The device is an ingestible capsule with a video camera at both ends that can take photographs as it progresses through the gastrointestinal tract.PillCam colon(PCC1) may be used for structural evaluation of the large bowel following an adequate cleaning procedure.PCC1 measures 11 mm×31 mm and has dual cameras that enable the device to acquire video images from both ends with a wide coverage area,automatic light control and a frame rate of four frames per second.The system includes a sensor array and data recorder connected to the patient during the procedure.The recorded data are downloaded to the Given Imaging Rapid workstation for review of the colon video.The second generation of PillCam Colon(PCC2) is similar to PCC1 and incorporates new developments.The angle of view has been increased to 172 degrees.It has an adaptive frame rate,alternating from 35 frames per second while in motion to 4 images when virtually stationary.The new RAPIDsoftware now includes a simple graphic interface tool for polyp size estimation.The procedure of bowel cleansing until capsule ingestion is similar to that used for traditional colonoscopy.However it is more rigorous as the bowel cleanliness for capsule colonoscopy has to be excellent or at least good to result in an adequate sensi-tivity of the method.Briefly,it consists of 3.5-4 L of split dose polyethylene glycol.Oral NaP boosters are administered after 1-2 h if the capsule has entered the small bowel.Sodium phosphate(NaP) seems to be a necessary adjunct to the regimen because the total transit time is doubled without NaP.The cleansing level was considered to be good to excellent in 72%-88%in studies with PCC1.The sensitivity for significant polyps(>6 mm or more than 3 polyps>3 mm) ranged from 63%-88% with specificities between 64%-94%.PCC2 showed an improved sensitivity of 89%and a specificity of 76%. CCE seems to be a safe and effective method of visualizing the colonic mucosa through colon fluids without the need for sedation or insufflation of air.The sensitivity of CCE to detect polyps,advanced adenomas and cancer is lower compared to optical colonoscopy but improvements will be made in the near future.With an increased recording duration,even a panenteric examination of the whole gastrointestinal tract may be possible.     

Colon capsule endoscopy

Wireless capsule endoscopy has become the first imaging tool for small bowel examination. Recently, new capsule endoscopy applications have been developed, such as esophageal capsule endoscopy and colon capsule endoscopy. Clinical trials results have shown that colon capsule endoscopy is feasible, accurate and safe in patients suffering from colonic diseases. It could be a good alternative in patients refusing conventional colonoscopy or when it is contraindicated. Upcoming studies are needed to demonstrate its utility for colon cancer screening and other indications such us ulcerative colitis. Comparative studies including both conventional and virtual colonoscopy are also required.     

Applications of Colon Capsule Endoscopy

Purpose of Review

This is a review of colon capsule endoscopy (CCE) with a focus on its recent developments, technological improvements, and current and potential future indications.

Recent Findings

Based on the current literature, CCE II demonstrates comparable polyp detection rates as optical colonoscopy and CT colonography, and improved cost-effectiveness. The main limitation to patient acceptance is the requirement of a rigorous bowel preparation. Preliminary studies show good correlation between CCE and optical colonoscopy for assessment of colonic disease activity in inflammatory bowel disease (IBD).

Summary

CCE II is currently FDA, approved as an adjunctive test in patients with prior incomplete colonoscopy, and in the evaluation of patients with suspected lower gastrointestinal bleeding. The test is approved in Europe as one of the options for average-risk colorectal cancer screening, and high-risk screening in patients with contraindications or unwilling to undergo colonoscopy. CCE has a potential role in the evaluation and monitoring of colonic disease activity in IBD. Future technological advances should focus on minimizing bowel preparation, improvement in reading times, and development of therapeutic capabilities.? With technological improvements, the second-generation colon capsule has a significantly higher sensitivity than the first-generation capsule for detection of colon polyps.? Colon capsule endoscopy has been approved in Europe as an option for average-risk colorectal cancer screening, and high-risk screening in patients with contraindications or unwilling to undergo colonoscopy.? Colon capsule endoscopy has received FDA approval as an option for colorectal cancer screening in patients with prior incomplete colonoscopy, and in evaluation of patients with suspected lower gastrointestinal bleeding.? Colon capsule endoscopy may have a role in evaluation and monitoring of inflammatory bowel disease.? Colon capsule endoscopy currently requires a bowel preparation that is more rigorous than colonoscopy.

     

Screening des kolorektalen Karzinoms

Colorectal cancer is common and suitable for screening. There is general agreement that screening for colorectal cancer in the asymptomatic population without familial risk should begin at age 50. The different screening methods can be separated into methods that mainly detect cancers (fecal occult blood tests, genetic stool tests, blood tests, and the M2-PK test) and methods that diagnose cancers and polyps (colonoscopy, sigmoidoscopy, CT/MRI colonography, and colon capsule endoscopy). Endoscopic methods enable detection and treatment of preneoplastic adenomas and, thus, make cancer prevention possible. In the current German S3 guideline, colonoscopy is recommended as the preferred screening test. For people unwilling to undergo endoscopic screening, the fecal occult blood test is an alternative. Colonoscopy has been part of the German Cancer Screening Program since 2002.     

Is there a role for colon capsule endoscopy beyond colorectal cancer screening? A literature review

Colon capsule endoscopy is recommended in Europe al-ternatively to colonoscopy for colorectal cancer screen-ing in average risk individuals. The procedure has also been proposed to complete colon examination in cases of incomplete colonoscopy or when colonoscopy is contraindicated or refused by the patient. As tissue samples cannot be obtained with the current capsule device, colon capsule endoscopy has no place in di-agnosing ulcerative colitis or in dysplasia surveillance. Nevertheless, data are accumulating regarding its fea-sibility to examine ulcerative colitis disease extent and to monitor disease activity and mucosal healing, even though reported results on the capsule’s performance in this field vary greatly. In this review we present the currently available evidence for the use of colon cap-sule endoscopy to complement colonoscopy failure to reach the cecum and its use to evaluate ulcerative coli-tis disease activity and extent. Moreover, we provide anoutlook on issues requiring further investigation before the capsule becomes a mainstream alternative to colo-noscopy in such cases.     

Capsule endoscopy: past,present, and future

A capsule endoscope is a swallowable wireless miniature camera for getting images of the gastrointestinal (GI) mucosa. The initial capsule endoscope model was developed by Given Imaging and approved in Western countries in 2001. Before the introduction of capsule endoscopy (CE) and double-balloon endoscopy (DBE), there was no effective modality for the evaluation and management of patients with obscure GI bleeding. Obscure GI bleeding is defined as bleeding of unknown origin that persists or recurs after a negative initial or primary endoscopy (colonoscopy or upper endoscopy) result. The first capsule endoscope model, which is now regarded as a first-line tool for the detection of abnormalities of the small bowel, was the PillCam SB. It was approved in Japan in April 2007. The main indication for use of the PillCam SB is obscure GI bleeding. Almost the only complication of CE is capsule retention, which is the capsule remaining in the digestive tract for a minimum of 2 weeks. A retained capsule can be retrieved by DBE. There are some limitations of CE in that it cannot be used to obtain a biopsy specimen or for endoscopic treatment. However, the combination of a PillCam SB and DBE seems to be the best strategy for management of obscure GI bleeding. Recently, several new types of capsule endoscope have been developed, such as Olympus CE for the small bowel, PillCam ESO for investigation of esophageal diseases, and PillCam COLON for detection of colonic neoplasias. In the near future, CE is expected to have a positive impact on many aspects of GI disease evaluation and management.     

Colon capsule endoscopy: Advantages,limitations and expectations. Which novelties?

Since the first reports almost ten years ago, wireless capsule endoscopy has gained new f ields of application. Colon capsule endoscopy represents a new diagnostic technology for colonic exploration. Clinical trials have shown that colon capsule endoscopy is feasible, accurate and safe in patients suffering from colonic diseases and might be a valid alternative to conventional colonoscopy in selected cases such as patients refusing conventional colonoscopy or with contraindications to colonoscopy or when colonoscopy is incomplete. Despite the enthusiasm surrounding this new technique, few clinical and randomized controlled trials are to be found in the current literature, leading to heterogeneous or controversial results. Upcoming studies are needed to prove the substantial utility of colon capsule endoscopy for colon cancer screening, especially in a low prevalence of disease population, and for other indications such as inflammatory bowel disease. Possible perspectives are critically analysed and reported in this paper.     

Colonoscopic miss rates determined by direct comparison of colonoscopy with colon resection specimens

OBJECTIVES: Colonoscopy is an effective method for discovery of adenomas and for colon cancer screening and prevention. Studies evaluating back-to-back colonoscopies have estimated significant miss rates but are limited by the lack of a definitive gold standard. Our study evaluated the sensitivity of colonoscopy compared with examination of surgically resected colon as a gold standard. METHODS: This was a retrospective analysis of patients who had a portion of colon surgically removed and had lower endoscopy within 5 months. The focus of the review was not for the particular lesion for which the surgery was indicated but, rather, for the synchronous lesions in the portions of bowel that were removed. Sensitivity was determined by counting the number of lesions detected at colonoscopy compared with those found in the surgically resected segment. RESULTS: A total of 73 synchronous lesions were present in the resected segments of 156 patients. Colonoscopy detected 56 of 73 the lesions (sensitivity 76.7%: 95% CI = 67-86). Of the 17 missed lesions, 14 of 17 (82%, 95% CI = 64-100) were < 1-cm polyps. Endoscopy overlooked one 1-cm adenoma in the ascending colon. Two cancers were missed, both in the same patient in whom endoscopy detected a sigmoid cancer but missed synchronous lesions in the cecal and ascending colon. CONCLUSIONS: Colonoscopy is an effective method of finding cancers and polyps, but it is associated with significant miss rates for polyps <1 cm. The entire bowel should be carefully evaluated to exclude synchronous tumors in patients with known colorectal cancer. Further improvement of colonoscopic techniques and technologies is warranted.     

Are repeat upper gastrointestinal endoscopy and colonoscopy necessary within six months of capsule endoscopy in patients with obscure gastrointestinal bleeding?

Background and Aim: Medicare reimbursement for capsule endoscopy for the investigation of obscure gastrointestinal bleeding in Australia requires endoscopy and colonoscopy to have been performed within 6 months. This study aims to determine the diagnostic yield of repeating these procedures when they had been non‐diagnostic more than 6 months earlier. Methods: Of 198 consecutive patients who were referred for the investigation of obscure gastrointestinal bleeding, 50 underwent repeat endoscopy and colonoscopy solely to enable reimbursement (35 females and 15 males; mean age 59.4 [range: 21–82] years). The average duration of obscure bleeding was 50.16 (range: 9–214) months. The mean number of prior endoscopies was 3 (median: 2) and 2.8 colonoscopies (median: 2). The most recent endoscopy had been performed 18.9 (median: 14; range: 7–56) months, and for colonoscopy, 19.1 (median 14; range 8‐51) months earlier. Results: A probable cause of bleeding was found at endoscopy in two patients: gastric antral vascular ectasia (1) and benign gastric ulcer (1). Colonoscopy did not reveal a source of bleeding in any patient. Capsule endoscopy was performed in 47 patients. Twenty four (51%) had a probable bleeding source identified, and another five (11%) a possible source. These included angioectasia (17 patients), mass lesion (2), non‐steroidal anti‐inflammatory drug enteropathy (2), Cameron's erosions (2), and Crohn's disease (1). Four patients undergoing repeat capsule endoscopy had a probable bleeding source detected. Conclusion: The yield of repeat endoscopy and colonoscopy immediately prior to capsule endoscopy is low when these procedures have previously been non‐diagnostic. Such an approach is also not cost‐effective.     

Diagnostic yield and safety of colonoscopy in Israeli patients in an open access referral system

BACKGROUND: Open access endoscopy allows reference of patients for endoscopic procedures without prior gastrointestinal consultation, allowing the procedure to be more accessible. This practice is becoming increasingly widespread in the United States and other countries and has become commonplace in clinical practice in Israel. The objective of our study is to bring forward our experience with an open access referral system for colonoscopy and to measure the yield and safety of colonoscopy in this system. METHODS: Between January 2001 and September 2003, 10,866 colonoscopies were performed. Patient's charts were reviewed for the following data: demographics, indication for endoscopy, endoscopic and histopathologic findings, and complications. The practice guidelines of the American Society for Gastrointestinal Endoscopy were used to assess appropriateness of colonoscopy. RESULTS: 3533 pathologic findings were found, in 2978 colonoscopies. 2336 polyps were removed, including 18% hyperplastic, 26% tubular adenomata, 13% villous adenomata, 11% tubulovillous adenomata. Advanced disease was found in 41% of pathologic findings, 11% were invasive cancer. Rate of colonoscopies "generally indicated" according to American Society for Gastrointestinal Endoscopy guidelines was 78% with a rate of colonoscopies "generally not indicated" of 22%. Colonoscopy was completed successfully to the cecum in 93% of patients. 0.08% had serious complications during or immediately after colonoscopy. CONCLUSIONS: Our results suggest that open access colonoscopy is a reliable and safe method for screening average risk population. As colonoscopy is becoming the recommended screening model for colorectal cancer this attitude of performing screening in an open access system could both cut costs in the future and improve availability, in an aim to become common practice.     

Splenic trauma: an unusual complication of colonoscopy with polypectomy

Nowadays, colonoscopy has become an invaluable tool in the diagnosis and treatment of diseases of the colon and rectum. Colonoscopy is still an invasive exam with several complications. The most common complications are perforation and bleeding, which occur in up to 1% after diagnostic colonoscopy and 3% of patients undergoing therapeutic colonoscopy. Less common complications include pneumothorax, pneumomediastinum, colonic volvulus, hernia incarceration, retroperitoneal abscess and mesenteric tear. Splenic rupture is a rare and potentially lethal colonoscopic complication with less than 45 cases reported in the world. The overall incidence is 0.004%. Mechanisms of injury and available treatment options remain discussed. We present a case of splenic rupture after colonoscopy with polypectomy in a 73-year-old woman managed first with nonoperative treatment and nine days later with surgical treatment. As the indications for colonoscopy expand, including the introduction of mass screening for colorectal cancer, endoscopists should be increasingly aware of that life-threatening complication after colonoscopy and know the emergency treatment.     

A Pilot Study of Sequential Capsule Endoscopy Using MiroCam and PillCam SB Devices with Different Transmission Technologies

Background/Aims

Studies have investigated the use of different types of radiofrequency capsules for comparison or sequential capsule endoscopy, but none have compared the MiroCam device - which utilizes a novel data transmission technology - with other capsules. This study compared the feasibility of sequential capsule endoscopy using the MiroCam and PillCam SB devices, which employ different transmission technologies.

Methods

Patients with diseases requiring capsule endoscopy were enrolled. After a 12-hour fast, one randomly selected capsule was swallowed. The second capsule was swallowed once fluoroscopy had indicated that the first capsule had migrated below the gastric outlet.

Results

The total operating time in 24 patients was 702±60 min (mean±SD) for the MiroCam and 446±28 min for the PillCam SB (p<0.0001). The rate of a complete examination to the cecum was 83.3% for the MiroCam and 58.3% for the PillCam SB (p=0.031). Diagnostic yields for the MiroCam, PillCam SB, and sequential capsule endoscopy were 45.8%, 41.7%, and 50.0%, respectively. The agreement rate between the two capsules was 87.5%, with a κ value of 0.74. Electrical interference in data transmission between the two capsules was not observed, but temporary visual interferences were observed in seven patients (29.2%).

Conclusions

Sequential capsule endoscopy with the MiroCam and PillCam SB produced slight but nonsignificant increases in the diagnostic yield, and the two capsules did not exhibit electrical interference. A larger trial is necessary for elucidating the usefulness of sequential capsule endoscopy.     

From colonic polyps to colon cancer: pathophysiology, clinical presentation, screening and colonoscopic therapy

Colon cancer is the most common nondermatologic cancer in Italy and throughout Europe, with about 250,000 cases annually in Europe, about half of whom die. Yet, colon cancer is largely preventable through intensive, mass screening programs to remove premalignant colonic polyps. The persistently high incidence and mortality is largely due to ineffective implementation of established screening protocols due to patient fears about screening tests, physician under-referral for screening, and test costs. Colon cancer mostly arises from adenomas, recognized as colonic polyps, but may occasionally arise from the sessile serrated adenoma. Adenomatous polyposis coli (APC) gene mutation is the key molecular step in adenoma formation. Mismatch repair gene mutation is a less common alternative pathway. Progression from adenomas to colon cancer is a multistep process, involving mutations of the DCC, k-ras, and p53 genes; loss of heterozygosity in which cells loose one allele of some genes from chromosomal loss; and DNA methylation which can silence DNA expression. Numerous environmental factors can increase the risk of colon cancer, presumably by modulating these molecular pathways. While colon cancer in an advanced and incurable stage often produces clinical findings, premalignant adenomatous polyps and early, highly curable, colon cancer are often asymptomatic. This phenomenon renders adenomas or early cancers difficult to detect by clinical presentation and provides the rationale for mass screening of asymptomatic adults over 50 years old for early detection and prevention of colon cancer. Colonoscopy is the primary screening test. All polyps identified at colonoscopy are removed by colonoscopic polypectomy. Endoscopic mucosal resection is required for deeply penetrating noncancerous polyps. Colonoscopy is repeated every ten years if the index colonoscopy revealed no lesions, but is repeated more frequently if adenomatous polyps were identified at this colonoscopy due to an increased risk of subsequent polyps or colon cancer. Flexible sigmoidoscopy every few years with annual fecal occult blood testing is a significantly less sensitive screening protocol. Virtual colonoscopy is controversial as a screening test due to widely variable reported RESULTS: Computerized tomography is standardly used to preoperatively detect distant colon cancer metastases, while endosonography is being increasingly used for locoregional staging of rectal cancer. Stool genetic markers and videocapsule endoscopy are promising, but currently experimental, screening tests.     

Colon capsule endoscopy: Detection of colonic polyps compared with conventional colonoscopy and visualization of extracolonic pathologies

BACKGROUND:

Conventional colonoscopy (CC) is the gold standard for diagnostic examination of the colon. However, the overall acceptance of this procedure is low due to patient fears of complications or embarrassment. Colon capsule endoscopy (CCE) represents a minimally invasive, patient-friendly procedure that offers complete visualization of the entire intestine.

OBJECTIVE:

To assess the PillCam Colon 2 (Given Imaging Ltd, Israel) capsule with regard to feasibility, sensitivity and specificity for the detection of colonic pathologies and additional recorded extracolonic findings.

METHODS:

CCE was performed before CC in patients indicated for CC for known or suspected colonic disease. The results of both techniques were compared with regard to polyp detection. Additionally, bowel preparation and extracolonic pathologies were analyzed.

RESULTS:

Twenty-four patients (mean age 51.1 years) were included in the analysis. Visualization of the colon was complete in 23 CCs and 17 CCEs. No adverse events or major technical failures occurred. CC detected 47 polyps and CCE detected 43 polyps of any size (per-finding sensitivity 90.9%, specificity 67.6%). The accuracy of CCE in detecting polyp carriers was 81.5% (per-patient analysis). On average, the colon was adequately cleansed in 90.1% of patients. CCE identified esophageal, gastric and small bowel pathologies in seven (24%), nine (38%) and 14 (58%) patients, respectively.

CONCLUSIONS:

CCE proved to be technically feasible and safe. Acceptable sensitivity and moderate specificity levels in polyp detection were recorded. Bowel preparation was adequate in most patients. Because extracolonic pathologies were effectively visualized, new indications for the PillCam Colon 2 may be defined.