Abetalipoproteinemia is a human genetic disease that is characterized by a defect in the assembly or secretion of plasma very low density lipoproteins and chylomicrons. The microsomal triglyceride transfer protein (MTP), which is located in the lumen of microsomes isolated from the liver and intestine, has been proposed to function in lipoprotein assembly. MTP activity and the 88-kilodalton component of MTP were present in intestinal biopsy samples from eight control individuals but were absent in four abetalipoproteinemic subjects. This finding suggests that a defect in MTP is the basis for abetalipoproteinemia and that MTP is indeed required for lipoprotein assembly.

Background. Colon capsule endoscopy (CCE) represents a noninvasive technology that allows visualization of the colon without requiring sedation and air insufflation. A second-generation colon capsule endoscopy system (PillCam Colon 2) (CCE-2) was developed to increase sensitivity for colorectal polyp detection compared with the firstgeneration system. Objective. To assess the feasibility, accuracy, and safety of CCE-2 in a head-to-head comparison with colonoscopy. Design and Setting. Prospective, multicenter trial including 8 European sites. Patients: This study involved 117 patients (mean age 60 years). Data from 109 patients were analyzed. Intervention. CCE-2 was prospectively compared with conventional colonoscopy as the criterion standard for the detection of colorectal polyps that are ≥6 mm or masses in a cohort of patients at average or increased risk of colorectal neoplasia. Colonoscopy was independently performed within 10 hours after capsule ingestion or on the next day. Main Outcome Measurements. CCE-2 sensitivity and specificity for detecting patients with polyps ≥6 mm and ≥10 mm were assessed. Capsule-positive but colonoscopynegative cases were counted as false positive. Capsule excretion rate, level of bowel preparation, and rate of adverse events also were assessed. Results. Per-patient CCE-2 sensitivity for polyps ≥6 mm and ≥10 mm was 84% and 88%, with specificities of 64% and 95%, respectively. All 3 invasive carcinomas were detected by CCE-2. The capsule excretion rate was 88% within 10 hours. Overall colon cleanliness for CCE-2 was adequate in 81% of patients. Limitations. Not unblinding the CCE-2 results at colonoscopy; heterogenous patient population; nonconsecutive patients. Conclusion. In this European, multicenter study, CCE-2 appeared to have a high sensitivity for the detection of clinically relevant polypoid lesions, and it might be considered an adequate tool for colorectal imaging.Abbreviations: CCE-2, second-generation colon capsule endoscopy; PEG, polyethylene glycol.

This Capsule Endoscopy Structured Terminology (CEST) is a copy− righted work, protected by United States and worldwide copy− right laws and treaties. Users of the CEST are hereby granted a free license to use, copy or distribute the CEST in connection with supporting a structured terminology for capsule endoscopy, subject to the following conditions: 1. This copyright and terms of use notice must be displayed on each and every copy of the CEST, on all manuals and other mate− rials used in connection with the CEST, including without limita− tion electronic media (i. e., disks, CD−ROMs, etc.), and in all text files loaded onto electronic media or the Internet. Such copyright and terms of use notice shall not be removed, obscured, modified or otherwise hidden. All references to the CEST, in whole or in part, shall properly cite the CEST as the source for such reference. Proper citation shall read "Capsule Endoscopy Structured Termi− nology (CEST), Endoscopy 2005; 37: 951 ± 959 (February 16, 2002 Given Imaging Ltd.)". 2. The CEST shall not be used, in whole or in part, to harm or de− grade the reputation of Given Imaging or any participant in the Given Capsule Standard Working Group (the "GCSWG"). 3. Neither Given Imaging nor any participant in the GCSWG shall be liable for any errors or omissions contained in the CEST, or for any use you or any third party may make of the CEST. Given Ima− ging reserves the right to make changes to the CEST without no− tice. The information contained in the CEST is provided on an "as is" basis without any warranties, express or implied, including but not limited to the results or effects obtained through use of information, or that it is fit for any use intended or can be used without infringing the copyright or other proprietary rights of any third party. All express and implied warranties, including those relating to title, non−infringement, merchantability or fit− ness for a particular purpose, are hereby expressly disclaimed and excluded with respect to any information provided hereun− der.

In the setting of this study, CCE seemed to be effective in detecting clinically significant colonic findings in patients with an indication of colonoscopy. The high NPV and excellent tolerance of CCE suggest that it could be evaluated in large CRC-screening programs and further studies in screening conditions should also evaluate its cost-efficacy ratio.

Double-balloon colonoscopy enables full colonic examination in almost all patients with a previous incomplete colonoscopy. The overtube should be used in most cases. The use of fluoroscopic assessment of scope progression could be reduced further with increasing experience.