Abstract
Background: Cleanliness, slow transit times, intermittent rapid movements, larger diameter lumen and capsule transmission times are challenges requiring study in order to use capsule endoscopy to image the colon. Aim: To assess colonic images received during experimental, human volunteer and clinical studies and improve wireless capsule imaging of the human colon. Methods: Colonic views obtained without preparation using M2A capsules with a 7-hr life were reviewed in 38 patients with obscure gastrointestinal bleeding. 34 volunteers took colonic prep and were studied with capsule. Collaborative work with Given Imaging allowed us to test longer life capsules. In 13, long-play capsules (LP) were used with 4 silver-oxide batteries and a potential transmission time of 10 hours. In 21, short-play capsules (SP) with 2 batteries and a 2 hour delay period were tested. In 14 patients, 7 LP and 7 SP were used. Results: In 38 clinical studies performed without colonic preparation, 35 had interpretable colonic images. Both LP and the SP capsules used with colonic preparation increased the number of interpretable colonic images compared with M2A (p<0.05). LP capsules and colon prep reduced oro-anal transit from 43+/−45 hrs to 20+/−15. Colo-anal transit was reduced from 38+/−47 hrs to 15+/−15. Comparing SP with LP, oro-anal transit was reduced from 31+/−10 hrs to 20+/−15. Colon passage time was reduced from 25+/−11 (LP) to 15+/−15 hrs (SP). Toilet was imaged in 3/34, in 7/34 capsules passed anus in <10 hours. Oral-caecal transit was median (4.5hr), range (1.5-8.5hrs). Oro-anal times were 0.5-4days). Clinical studies in n=14 patients revealed missed colon cancer, bleeding Meckel's diverticulum, occult Crohn's disease (2), missed colonic polyps (2), angiodysplasia (2). Capsules used in patients with incomplete colonoscopies provided useful clinical information. Conclusion: Wireless capsule colonoscopy is feasible and delivered valuable information in clinical studies. Technical development and better preparation is needed to improve the images of the colon in patients. Capsule colonoscopy was a useful adjunct to conventional colonoscopy especially in patients with difficult recurrent bleeding or incomplete colonoscopy.
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