PillCam Colon for Incomplete Colonoscopy

Abstract

Introduction: Optical colonoscopy (OC) is the current gold standard for colorectal cancer screening. Successful cecal intubation is critical because interval colon cancer is often located in the proximal colon. The literature reports an incomplete colonoscopy (IC) rate of about 13%. Recently, PillCam Colon has been FDA approved for IC in the United States. The aim of this abstract is to demonstrate the effectiveness of PillCam Colon for IC. Methods: Between 2012 to 2013 there were 6 trials1-6 using PillCam Colon as the second line next test for patients with IC. These studies focused on patient demographics, PillCam Colon completion rate, adequate cleansing, and polyps identified. Results: A total of 503 patients were enrolled with 486 included in the final analysis. The majority of patients were female (59%) with an average age of 60.6 years based on data from 4 out of the 6 studies (N=316). In 454 patients (93.4%; 95% CI 91, 95) PillCam Colon was able to visualize the portion of colon not reached by reached by OC. In 78.6% (95% CI 75, 82) of the cases PillCam Colon was excreted from the rectum. The bowel preparation was evaluated in 5 out of the 6 studies (N=390) and judged to be adequate overall for the entire colon (excellent or good) in 72% (95% CI 67, 76) of the capsule procedures. The diagnostic yield of capsule for detecting patients with polyps of any size at all colon segments was evaluated in 4 out of the 6 studies (N=311) with total yield of 46% (95% CI, 41, 52), and the yield for detecting patients with polyps of any size at the colon segments that were not reached by colonoscopy procedure was 33% (95% CI 26, 40) based on the results of 3 studies (N=183). Significant polyps (i.e., polyps ≥6 mm) at the colon segments missed by colonoscopy procedure based on 4 studies’ results (N=316) were found in 19% (95% CI 15, 23) of the cases and ranged from 12% to 23%. Subsequent colonoscopy examinations were able to identify and remove these polyps in the majority of patients. There were no complications reported. Conclusion: PillCam Colon is now approved in the United States for IC. PillCam Colon is a safe noninvasive alternative for second-line screening for colorectal cancers. Future studies are needed to better standardize the bowel preparation to ensure higher cleansing rates and completion rates.