PillCam© Colon Capsule for the study of colonic pathology in clinical practice: Study of agreement with colonoscopy

Abstract

Introduction: several studies have pointed out the effectiveness of the PillCam© colon capsule endoscopy (CCE) compared with the colonoscopy in the study of the colonic pathology.Aims and methods: the objective of our study was to assess the agreement in the diagnosis of CCE with conventional colonoscopy as well as its sensitivity and specificity, and to describe the findings of the CCE in our clinical practice. Consecutive patients with abdominal symptoms were included in the study. The CCE was performed as previously reported (with PEG and sodium phosphate as laxative agents). The nature and location of the findings, colonic transit time, complications, cleanliness degree and consistency with diagnostic colonoscopy, when performed, were analyzed.Results: a total of 144 subjects (67 women and 77 men); (52.17±16.71 years) with the following indications were included: screening of Colorectal cancer (88 patients), control after polipectomy (24), incomplete colonoscopy (7), rectal bleeding (10), anemia (8), diarrhea (7). The CCE exploration was complete in 134/144 cases (93%), with no case of retention. The preparation was good-very good in 88/134 (65,6%), fair in 26/134 (19,4%) and poor in 20/134 (15%) of the cases. The average colonic transit was of 140.76 min (9-603). Any adverse effect was notified.In 44 cases a colonoscopy was carried out after CCE (results were hidden from another endoscopist). Compared to colonoscopy, the rate of agreement was 75,6%, the sensitivity was 84% and the specificity 62,5%, PPV was 77,7% and NPV was 71,4 %.The colonic findings in 134 CCE were: in 34 cases CCE it did not show lesions, diverticulosis in 63 explorations, polyps in 43, angiodysplasias in 15, Crohn´s Disease in 9 and ulcerative colitis in other 8 cases.Conclusions: the CCE is an effective and reliable technique for the detection of lesions in colon, and because of its high agreement with the colonoscopy, it could be useful in clinical practice. Further studies with large seria and cost-effectiveness analysis are needed to confirm these data. INTRODUCTIONCapsule endoscopy has been established as the diagnosis of obscure gastrointestinal bleeding and in other small bowel suspected lesions (1-3) and it is known to be useful only for the study of small bowel mucosa injuried (4). Following the path marked by this capsule, a colon capsule endoscopy has been developed. Several studies have pointed out the effectiveness of the PillCam© colon capsule endoscopy (CCE) compared to the colonoscopy in the study of the colonic pathology (5,6).The CCE is similar to the conventional capsule but has two cameras which are able to record video images from both ends. The device measures 31 by 11 mms and acquires images at a rate of 4 frames per second. The preprogrammed "sleep" mode allows recording of images from the esophagus and the stomach for 3 minutes and after that capsule switches to sleep mode for 1 hour 45 minutes, so that it saves battery. During this period, the capsule is likely to transit most of the small bowel and reaches ap...

Bowel preparation regimens for colon capsule endoscopy: a review

“…In a study by Eliakim and colleagues patients were started on a low-fiber diet and adequate colon cleanliness was achieved in 88% [Eliakim et al 2006]. But a few other studies failed to improve colon cleanliness using a low-fiber diet [Herrerias-Gutierrez et al 2011;Spada et al 2011a], while other studies achieved comparable colon cleanliness without a low-fiber diet [Iddan et al 2000;Gay et al 2010]. However, most studies have included a clear liquid diet a day before the procedure.…”

“…This drug is not available in the USA as it was withdrawn in 2007 by the US Food and Drug Administration due to the possible risk of cardiovascular disease. Domperidone, an antidopaminergic drug, has been more widely used in studies without any clear benefit [Eliakim et al 2006;Schoofs et al 2006;Sieg et al 2009;Van Gossum et al 2009;Herrerias-Gutierrez et al 2011;Spada et al 2011bSpada et al , 2011c. More recently mosapride, also a 5HT4 agonist which accelerates gastric emptying, has been used by Kakugawa and colleagues [Kakugawa et al 2012].…”

“…PEG has been used primarily as a laxative in bowel preparation using CCE. A large-volume (3-4 liters of PEG) lavage has been used in the majority of the studies [Eliakim et al 2006[Eliakim et al , 2009Schoofs et al 2006;Sieg et al 2009;Van Gossum et al 2009;Gay et al 2010;Herrerias-Gutierrez et al 2011;Sieg, 2011;Spada et al 2011aSpada et al , 2011bSpada et al , 2011c. The use of 4 liters of PEG before CCE has also been recommended by the European Society of Gastroenterointestinal Endoscopy (ESGE) Guideline (evidence level 4, recommendation grade D) [Hassan et al 2008].…”

“…In recent years colon capsule endoscopy (CCE) has been under evaluation for visualization of the colon [Eliakim et al 2006[Eliakim et al , 2009Schoofs et al 2006;Sieg et al 2009;Gay et al 2010;Spada et al 2010;Herrerias-Gutierrez et al 2011;Sieg, 2011]. The advantages of CCE as an alternative to the standard colonoscopy as a screening test for colorectal cancer (CRC) might be attractive for a subset of patients.…”

Colon capsule endoscopy: toward the future

“…In an analysis of over 1600 reported cases involving both first-and second-generation CEs, the minor complication rate was 4.1 %, while the major complication rate was 0.49 %, not being directly related to CCE [25]. Reports stated that the major complication of perforation was derived from the particular performance of the colonoscopy, including the therapeutic interventions undertaken [44][45][46] (Table 2). Some case reports raised the possibility of capsule aspiration [47] and retention in a diverticulum [48].…”