S1641 Utility of Colon Capsule Endoscopy in Diagnosis of Colorectal Cancer

Abstract

INTRODUCTION: Colonoscopy is the gold standard for diagnosis of colorectal cancers. Recent advances in endoscopic technologies has introduced Video capsule endoscopy, which has become widely used to evaluate small bowel and large mucosa for obscure bleeding and even mass lesions. This has led to colon capsule endoscopy (CCE). CCE was introduced in late 2000s and has gained popularity due to non-invasive, and efficacious method in diagnosis of colon lesions. CASE DESCRIPTION/METHODS: We present a case of a 68 yo man with hematochezia for three months. His PMHx includes A fib (takes coumadin). He had intermittent bleeding with bowel moments where he noticed fresh bleed in toilet bowel. He denied any abdominal pain, constipation, diarrhea, or weight loss. His physical exam was benign. His hemoglobin was 14.5 g/dl. No prior endoscopic procedures. He was offered colonoscopy however patient was not amenable to the procedure. Therefore, we offered colon capsule endoscopy (CCE). The CCE was of good quality. Colon was well visualized and showed an ulcerated lesion in the distal rectosigmoid area, occupying more than 70% of the lumen, measuring at least 5 cm in diameter that was concerning for cancer. With this finding, patient was agreeable to proceeded with colonoscopy. Colonoscopy to the ileum (BBPS 3,3,3) showed a rectosigmoid mass seen on capsule colonoscopy at 16 cm from the anal verge. Lesion was non obstructing and occupied 70% of the luminal circumference. Multiple biopsies were taken. Biopsies were consistent with moderately differentiated adenocarcinoma. He was referred to general surgery and oncology. He underwent Lower Anterior Resection. Path showed locally advanced rectal cancer. DISCUSSION: With this case, we intent to highlight the utility of CCE as a screening and diagnostic tool for Colorectal cancer. CCE has emerged as a promising new modality for colonic evaluation. As this procedure is non-invasive, and painless, there is no need for sedation. The patient’s do not need to be off of anticoagulation and take significant time of for colonoscopy that usually requires one to two days of leave. Hence, it a good diagnostic and screening tool for appropriate candidates who do not wish to undergo routine colonoscopy. The limitations include unable to do biopsies, polypectomies and provide therapeutic options for patients with mass lesions, polyps or bleeding. Therefore, CCE can be utilized to decide if colonoscopy is warranted in individuals based on CCE findings.Figure 1.: Colon Capsule Endoscopy imaging of rectosigmoid tumor.Figure 2.: Colon Capsule Endoscopy imaging of rectosigmoid tumor.Figure 3.: Colonoscopy image of circumferential mass lesion in rectosigmoid identified on colon capsule endoscopy.