Therapeutic impact of colon capsule endoscopy with PillCam™ COLON 2 after incomplete standard colonoscopy: a Spanish multicenter study

Abstract

Introduction: Colon capsule endoscopy (CCE) is an alternative approach for the examination of the colon in patients who refuse colonoscopy or after incomplete colonoscopy (IC). We conducted a study to determine the frequency of complete colonoscopy after IC, the diagnostic yield of CCE, the therapeutic impact of lesions found in CCE, the level of colon cleanliness and the safety of the procedure.Methods: We performed a prospective, multicenter study involving ten Spanish hospitals. Consecutive outpatients aged ≥ 18 years with previous IC were invited to participate. The latest version of the CCE device, PillCam™ COLON 2 (CCE-2), was administered to all patients according to the protocol.Results: The study population comprised 96 patients. The most frequent cause of IC was the inability to move past a loop using standard maneuvers (75/96 patients, 78%). Complete visualization of the colon was obtained with CCE-2 in 69 patients (71.9%). Of the 27 patients in whom the CCE-2 did not reach the hemorrhoidal plexus, it passed the colonic segment explored with the previous colonoscopy in 20 cases; therefore, it could be inferred that a combined approach (CCE-2 plus colonoscopy) enabled complete visualization of the colonic mucosa in 92.7% of patients. CCE-2 revealed new lesions in 58 patients (60.4%). Polyps were the most frequent finding (41 patients; 42.7% of the total number of patients). In 43 of the 58 patients (44.8% of the total number of patients), the new lesions observed led to modification of therapy, which included a new colonoscopy for polyp resection or surgery in patients with colonic neoplasm.Conclusions: CCE-2 is a suitable diagnostic procedure that can lead to more frequent diagnosis of significant colonic lesions after IC.

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 ].…”

“…During incomplete colonoscopy (IC), the scope rarely reaches the ascending colon (4–25%), and colonoscopy is often terminated in the sigmoid colon (22–43%) [ 1 , 2 , 3 , 4 ] or the rectum (6–10%) [ 3 , 5 ], necessitating further evaluation of the colon. Usually, this is performed by repeat colonoscopy or computed tomography colonography (CTC).…”

PillCamColon2 after incomplete colonoscopy - A prospective multicenter study

“…Adequate cleansing following use of the PillcamColon1 was observed in 76% of patients following consumption of 1-2 L Moviprep and two NaP boosts in a mixed cohort, including 28% of patients with contraindicated colonoscopy without anatomical problems[ 19 ]. A recent Spanish multicentre trial found adequate cleansing levels in 75% of patients using a standard 4 L PEG preparation with a NaP booster for PillCamColon2 after an incomplete colonoscopy[ 26 ]. Even in a large trial in a screening population without negative selection towards unfavorable anatomy, CCE was technically insufficient in 9% of patients due to inadequate cleansing or rapid transit of the capsule[ 27 ].…”

A global perspective on capsule endoscopy

“…This procedural difference is utilized in the case of unsuccessful colonoscopies, procedures where the endoscope did not reach the cecum. A capsule is regularly able to visualize the unseen segment as shown in clinical trials (19,20) and in daily clinical routine (21). In 2012, this was one indication that was recommended by the ESGE that published a comprehensive guideline (22).…”