PillCamColon2 after incomplete colonoscopy - A prospective multicenter study

Abstract

AIMTo evaluate the ability of PillCamColon2 to visualize colonic segments missed by incomplete optical colonoscopy (OC) and to assess the diagnostic yield.METHODSThis prospective multicentre study included 81 patients from nine centres who underwent second-generation colon capsule endoscopy (CCE) following incomplete OC performed by an experienced gastroenterologist (> 1000 colonoscopies). Patients with stenosis were excluded. According to patient preferences, CCE was performed the following day (protocol A) after staying on clear liquids and 0.75 L Moviprep in the morning or within 30 d after new split-dose Moviprep (protocol B). Boosts consisted of 0.75 L and 0.25 L Moviprep, and phospho-soda was given as a rescue if the capsule was not excreted after seven hours.RESULTSSeventy-four patients were analysed (51% of them in group A; 49% in group B). Bowel cleansing was adequate in 67% of cases, and CCE could visualize colonic segments missed by incomplete colonoscopy in 90% of patients under protocol A and 97% of patients under protocol B (P = 0.35, n.s.). Significant polyps including adenocarcinoma were detected in 24% of cases. Detection rates for all polyps and significant polyps per patient were similar in both protocols. Polyps were found predominantly in the right colon (86%) in segments that were not reached by OC. Extracolonic findings - such as reflux esophagitis, suspected Barrett esophagus, upper GI-bleeding, gastric polyps, gastric erosions and angiectasia - were detected in eight patients. PillCamColon2 capsule was retained in the ileum of one patient (1.4%) without symptoms and removed during an uneventful resection for unknown Crohn’s disease that was diagnosed as the cause of anemia, which was the indication for colonoscopy. CCE was well tolerated. One patient suffered from self-limiting vomiting after consuming the phospho-soda.CONCLUSIONSecond-generation CCE using a low-volume preparation is useful after incomplete OC, and it allows for the detection of additional relevant findings, but cleansing efficiency could be improved.

Colon Capsule Endoscopy vs. CT Colonography Following Incomplete Colonoscopy: A Systematic Review with Meta-Analysis

“…This resulted in a further four included studies ( Figure 1 ). In total, 26 studies were included in this meta-analysis [ 1 , 2 , 3 , 4 , 5 , 10 , 11 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ].…”

“…If CCE is better for detecting small lesions compared to CTC, it may still be inhibited by a completion rate that is dependent on the battery lifetime exceeding the total transit time of the capsule. CCE after IC may not need to be complete if it is conclusive (i.e., has a positive finding or reaches the most proximal point seen during the IC) [ 3 , 4 , 10 , 11 ]. The overall goal should therefore be that individuals must have a complete colonic visualization following IC and CCE.…”

Early detection and therapeutics

“…VCE detected significant polyps (size ≥ 6 mm or number ≥ 3) in 24% of cases. Importantly, most of the polyps (86%) were found in the right side of the colon, comprising segments that could not be visualised before as a result of incomplete endoscopy (Baltes et al, 2018).…”

Colonoscopy technologies for diagnostics and drug delivery

“…Furthermore, they achieved an overall specificity of 85.7% and 88.1% (Alarcón‐Fernández et al, ; Baltes et al, ; Pioche et al, ; Spada et al, ). For polyps greater than 10 mm, CCE and CCE‐2 achieved an overall sensitivity of 54% and 87.2%, respectively, achieving an overall specificity of 97.4% and 95.3% (Alarcón‐Fernández et al, ; Baltes et al, ; Pioche et al, ; Spada et al, ). Therefore, the use of CCE‐2 is more effective in the diagnosis of polyps, with CCE‐2 also having a slightly better rate of capsule excretion compared to CCE (86.7% vs. 90.5%), (Yung et al, ).…”