Same‐day colon capsule endoscopy is a viable means to assess unexplored colonic segments after incomplete colonoscopy in selected patients

Abstract

Background Same-day colon capsule endoscopy (CCE) immediately following incomplete optical colonoscopy (OC) would have a number of advantages for patients, while also presenting unique procedural challenges including the effect of sedation on capsule propulsion and patient tolerance of protracted preparation and fasting. Aim The aim of this article is to prospectively assess the efficacy of same-day CCE after incomplete OC in an unselected patient cohort. Methods This was an observational, prospective, single-centre study of CCE post-incomplete colonoscopies. Patients with an incomplete OC for any reason other than obstruction or inadequate bowel preparation were recruited. CCE was performed after a minimum of a one-hour fast. Once the patient was fully alert, intravenous metoclopramide was administered after capsule ingestion when possible, and a standard CCE booster protocol was then followed. Relevant clinical information was recorded. CCE completion rates, findings and their impact, and adverse events were noted. Results Fifty patients were recruited, mean age = 57 years and 66% ( n = 32) were female. Seventy-six per cent ( n = 38) of CCEs were complete; however, full colonic views were obtained in 84% ( n = 42) of cases. Patients > 50 years of age were five times more likely to have an incomplete CCE and there was also a trend towards known comorbidities associated with hypomobility having reduced excretion rates. Overall diagnostic yield for CCE in the unexplored segments was 74% ( n = 37), with 26% ( n = 13) of patients requiring significant changes in management based on CCE findings. The overall incremental yield was 38%. CCE findings were normal 26% ( n = 13), polyps 38% ( n = 19), inflammation 22% ( n = 11), diverticular disease 25 ( n = 12), angiodysplasia 3% ( n = 1) and cancer 3% ( n = 1). Significant small bowel findings were found in three (6%) cases, including Crohn’s disease and a neuroendocrine tumour. A major adverse event occurred in one patient (2%), related to capsule retention. Conclusion Same-day CCE is a viable alternative means to assess unexplored segments of the colon after incomplete OC in selected patients.

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 ].…”

“…Five CCE studies were included for the analysis ( Figure 5 ). One CCE study was excluded, as it did not report polyps per patient [ 3 ] and two as polyps >9 mm could not be differentiated from smaller polyps [ 2 , 10 ]. Eight CTC studies were included.…”

“…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.…”

Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline – Update 2020

“…Two studies analyzed the possibility of performing CCE on the same day after an incomplete colonoscopy. Hussey et al [36] used sodium phosphate booster plus 1 L of gastrografin to perform CCE-2 on the same day after the incomplete colonoscopy, with an overall completion rate of 76 %, a full colonic visualization in 84 %, and a mean colon passage time of 233 minutes. Image quality was considered suboptimal in 9 % of patients.…”

Colon Capsule Endoscopy for Inflammatory Bowel Disease

“…Currently, CCE-2 is primarily utilized in screening for colonic neoplasia, 6 particularly in situations such as incomplete colonoscopy. 7,8 Although CCE-2 has several limitations, including high preparation volume and cost, the demand for CCE-2 in clinical settings is gradually increasing. CCE is non-invasive and especially useful for patients with inflammatory bowel disease (IBD) and ulcerative colitis (UC) in particular.…”