Colon Capsule Endoscopy In Patients Research Articles

Exploring the feasibility of home-delivered capsule endoscopy with 5G support: innovations and carbon footprint insights.

Colorectal cancer (CRC) poses a significant global health threat, necessitating early detection. Traditional diagnostic tools like optical colonoscopy have limitations prompting our '5G-SUCCEEDS' initiative to explore a novel approach involving remote colon capsule endoscopy (CCE). This prospective feasibility study was conducted at a single hospital in England. Between December 2022 and September 2023, we introduced a remote CCE service within the 5G-SUCCEEDS framework. We undertook a feasibility study of CCE in patients with low-risk/moderate-risk CRC stratified by faecal haemoglobin. Outcomes included carbon footprint analysis (outlined through three potential clinical pathways) and patient-reported outcomes through structured questionnaires and interviews. Among 25 participants, 88% expressed satisfaction with remote CCE. 82% were willing to have remote CCE if clinically indicated in future. CCE findings included adenomatous polyps (58%), normal results (17%) and diverticulosis (21%), with no cancers identified in this pilot. Notably, we found that the carbon footprint associated with delivery of CCE at home (pathway 3) was lower compared with CCE delivered in a clinical setting (pathway 2). A fully optimised, automated scaled-up pathway would combine the delivery and collection of CCE equipment within a local area to reduce the carbon footprint of the travel element by 75%. Moreover, the conversion rate into a colonoscopy pathway is not static and clinicians acknowledge that this could be as low as 28%. Carbon footprint is more favourable for home-delivered CCE in the optimised scenario, while less so when considering the need for additional procedures (colonoscopy conversion). The 5G-SUCCEEDS initiative highlights the feasibility and advantages of home-based diagnostics using CCE.

Feasibility of patency capsule and colon capsule endoscopy in patients with suspected gastrointestinal stenosis: a prospective study.

ABSTRACTPatency capsule (PC) can evaluate the patency of gastrointestinal (GI) tract. We hypothesized preceding patient selection using PC would improve the successful rate of colon capsule endoscopy (CCE). Therefore, a prospective single-arm study using PC followed by CCE was conducted with a control group of CCE alone. Patients with suspected or known GI stenosis scheduled for CCE were enrolled. CCE was performed only when the PC was excreted out of the body within 33 hours of ingestion. Primary endpoint was the rate of observation of the entire GI tract within the duration of examination. The secondary endpoints were complications and CCE findings. Twenty-three patients (17 men) were enrolled. The mean age was 50.5±19.8 years. Suspected stenotic sites were 8, 5, and 10 in the small, large, and small and large bowel, respectively. Sixteen, 12, and 10 patients had abdominal pain, active inflammatory bowel disease, and history of surgery for suspected stenosis, respectively. Patency of GI tract was confirmed in 96% (22/23) of the patients by administered PC. Of the 22 patients who underwent CCE, the entire GI tract was observed in 86% (19/22). No complications were observed. The median transit times in the small bowel and colon were 99 (21–682) and 160 (5–328) minutes, respectively. CCE findings revealed ulcers, erosions, and diverticula in 5, 9, and 4 patients, respectively. In conclusion, CCE with PC might be a safer and useful modality to observe the large colon for patients with suspected GI stenosis.

Colon capsule endoscopy in patients with chronic respiratory disease during the COVID‐19 pandemic

Dear Editor, We read with interest the article by MacLeod et al. [1]. The authors suggest that colon capsule endoscopy (CCE) could be a useful tool for triaging emergency colonoscopy during the COVID-19 pandemic. The literature for CCE in patients with chronic respiratory disease, who comprise one of the COVID-19 high-risk groups [2], is limited. We carried out a retrospective study of CCE in patients with chronic respiratory disease up to May 2020, the first wave of the COVID-19 pandemic in Japan. Thirty-one patients (18 men and 13 women with a mean age of 65.2 ± 15.1 years) with chronic respiratory disease who underwent CCE at our hospital were included. The diagnoses of these patients were pulmonary emphysema in seven patients, bronchial asthma in seven patients, chronic bronchitis in six patients, sleep apnoea syndrome in two patients, pulmonary tuberculosis (old and latent) in eight patients and nontuberculous mycobacteriosis in one patient. The reasons for the procedure were as follows: screening in seven patients, positive for a faecal occult blood test in four patients, lower abdominal pain in five patients, diarrhoea in two patients, abnormal bowel movement in five patients, narrowing of the stool column in one patient, follow-up for Crohn's disease in one patient, suspicion of irritable bowel syndrome in three patients and accumulation of positron emission tomography in the transverse colon in one patient. The overall total colorectal detection rate using CCE was 90.3% (28/31). Polyps were detected in 54.8% of patients by CCE (17/31 cases), and a significant finding (polyp lesion of 6 mm or more) was observed in 64.7% (11/17 cases). Colonoscopy (CS) was performed in 45.1% (14/31). The positive predictive value was 100% (17/17 patients) and the negative predictive value (13/14 patients) was 92.9%. Histopathological examination by therapeutic endoscopy using CS with personal protective equipment revealed six cases of adenoma, six cases of hyperplasia, one case of carcinoma in situ and no advanced cancer. There were no adverse events, such as retention, in any patient and no evidence of SARS-Cov-2 infection in healthcare professionals. There is a report suggesting the possibility of colon CT examination [3] and positron emission tomography [4] as an alternative method during the COVID-19 pandemic. However, CCE is free from radiation exposure and the only examination that can be performed at home without coming to hospital during the pandemic. CCE is expensive, it costs the national health insurance adaptation of Japan approximately ￥30 000 at a 30% burden. However, it can be easily inferred that in patients with chronic respiratory disease it is more cost-effective than the medical cost of ventilators and extracorporeal membrane oxygenation in intensive care units if they become seriously ill with SARS-Cov-2 infection. Also, in Japan, CCE was adopted by the national health insurance plan for chronic obstructive pulmonary disease from March 2020. Our study results suggest that CCE in patients with chronic respiratory disease avoids unnecessary CS and may reduce the risk of SARS-Cov-2 infection by CS in approximately 60% of the patients. All patients consented to data collection, analysis and dissemination. The author participated in the interpretation of study results, and in the drafting, critical revision, and approval of the final version of the manuscript. I declare no conflict of interests. This study was approved by the ethics committee. The data that support the findings of this study are openly available in [repository name e.g. “figshare”] at 10.6084/m9.figshare.13278059.

Diagnostic Role of Colon Capsule Endoscopy in Patients with Optimal Colon Cleaning.

Background. Colon capsule endoscopy (CCE) is a diagnostic test with relatively rare usage. In this study, we aimed to evaluate both the optimal cleaning regimen for CCE and the diagnostic value of test in the study group. Methods. A total of 62 patients were enrolled in this study. In the first step, 3 different colon preparing regimens were given to 30 patients [Group A: 3 days of liquid diet, sodium phosphate (NaP) (90 mL), and NaP enema; Group B: 3 days of liquid diet, 4 L of polyethylene glycol (PEG), and metoclopramide; Group C: 3 days of liquid diet, 4 L of PEG, NaP (45 mL), and bisacodyl after capsule ingestion] (10 patients in each group). The other consecutive 32 patients were cleaned with the best regimen which was NaP + PEG and CCE was performed. The results of CCE were controlled with colonoscopy in 28 patients. Results. Group C had the highest cleaning score, compared with the other groups (2.2 ± 0.4 versus 2.7 ± 0.4 versus 3.7 ± 0.4, p value = 0.000). The CCE findings were as follows in 28 patients who were also examined with colonoscopy: polyp (range: 5–10 mm) in 6 patients, internal hemorrhoids in 3 patients, angiodysplasia in 1 patient, diverticula in 1 patient, and ulcerative colitis in 1 patient. The sensitivity, specificity, PPV, and NPV of CCE were 100%, 92%, 93%, and 100%, respectively. Conclusions. Low dosage NaP combined with PEG provides optimal bowel preparation for CCE. CCE appears to be a highly sensitive diagnostic modality for detecting colonic pathologies.

Colon Capsule Endoscopy in Patients at Elevated Risk of Colonoscopy-Associated Adverse Events Presidential Poster

Colon Capsule Endoscopy in Patients at Elevated Risk of Colonoscopy-Associated Adverse Events Presidential Poster

Modified bowel preparation regimen for use in second‐generation colon capsule endoscopy in patients with ulcerative colitis

We have reported that second-generation colon capsule endoscopy (CCE-2) might be feasible for assessing the severity of mucosal inflammation in ulcerative colitis (UC). However, because of the low rate (69%) of complete evaluation of the colon and owing to inadequate cleansing. We believe that the method of bowel preparation could be improved by reducing volume. In the present study, we attempted to improve the colon-cleansing regimen in order to optimize the usefulness of CCE-2 in the management of UC patients. Twenty patients with histologically confirmed UC were enrolled. Patients took a maximum 2.2 L lavage solution (polyethylene glycol solution and magnesium citrate) in two or three divided doses. To assess the effectiveness of the modified bowel preparation regimen, we evaluated the rate of total colonobservation, the effectiveness of bowel cleansing, andinterobserver agreement in assessing UC disease activity. We used a four-point grading scale (poor, fair, good, and excellent) for evaluating the quality of bowel cleansing. Matts' endoscopic score was used to evaluate disease activity. The rate of total colon observation was 85%, and 15 patients (75%) excreted the CCE-2 within 8 h. The proportion of excellent plus good cleansing was approximately 60%. There was a substantial interobserver agreement (κ = 0.777) in assessment of overall cleansing, which was still substantial at the fair cleansing level (κ = 0.700). Using CCE-2, the modified bowel preparation regimen, with reduced volume has the potential to succeed in the evaluation of mucosal severity in UC.

Mo1603 Feasibility of the Second-Generation Colon Capsule Endoscopy in Patients With Ulcerative Colitis With a Reduced Preparation Regimen

Feasibility of the Second-Generation Colon Capsule Endoscopy in Patients With Ulcerative Colitis With a Reduced Preparation Regimen Taku Kobayashi*, Naoki Hosoe, Katsuyoshi Matsuoka, Makoto Naganuma, Masaru Nakano, Yuka Ishibashi, Kayoko Kimura, Kazuaki Yoneno, Shingo Usui, Kazuhiro Kashiwagi, Tadakazu Hisamatsu, Nagamu Inoue, Hiroshi Serizawa, Noriaki Watanabe, Takanori Kanai, Hiroyuki Imaeda, Haruhiko Ogata, Toshifumi Hibi IBD Center, Kitasato University Kitasato Institute Hospital, Minato-ku, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, Shinjuku-ku, Japan; Center for Diagnostic and Therapeutic Endoscopy, Keio University, Shinjuku-ku, Japan; Department of General Internal Medicine, Saitama Medical University, Saitama, Japan Background: Patients with ulcerative colitis (UC) may need frequent colonoscopy for monitoring disease activity, as endoscopic mucosal healing is emerging as a critical parameter to optimize the management strategy. Therefore, increasing the patient’s tolerability for colon endoscopy is crucial in the management of UC. Second-generation colon capsule endoscopy (CCE-2) serves as a noninvasive diagnostic tool in screening colorectal neoplasms with improved endoscopic images. However, unlike conventional colonoscopy, incapability of aspirating the luminal content by the device requires larger colonic preparation volume, as much as 5 to 6 L of polyethylene glycol (PEG). In this study we hypothesized that 1) CCE-2 is a feasible method to visualize the mucosal inflammation in UC, and 2) a smaller volume of bowel preparation may be sufficient for the purpose of evaluating disease activity in UC patients. Methods: Study 1: Twenty-nine patients with UC ingested CCE-2 followed by the single dose of 2L PEG in combination with prokinetics (mosapride itrate and metoclopramide). Findings were recorded for 8 hours and conventional colonoscopy was subsequently performed on the same day. Completion rate was calculated based on the excretion of capsule in 8 hours, and the bowel cleanliness was scored in a 4point grading scale (poor, fair, good, and excellent) for 5 sections of colon (cecum, ascending, transverse, proximal left-side, and distal left-side). Matts’ endoscopic grades were determined and compared by both CCE-2 and conventional colonoscopy for each section. Four endoscopists blinded for the conventional colonoscopic findings scored bowel cleanliness and disease severity. Study 2: Preparation protocol was further modified in 20 patients with split-dose of bowel preparation. Briefly, CCE-2 was ingested 2 hours after 700 ml of PEG, followed by the booster dose of 900-1500 ml isotonic magnesium citrate solution. Results: Study 1: Completion rate was 69.0% (20/29). Matts’ endoscopic grades showed a strong correlation between CCE and conventional colonoscopy in all sections (overall average 0.797, Spearman’s rank correlation coefficient test) despite bowel cleanliness seeming insufficient (good or excellent 50%). Study 2: Completion rate was improved up to 85.0% (17/20) with comparable quality of images to Study 1. Conclusions: CCE-2 is a well-tolerated and feasible tool for evaluating disease activity in UC. Endoscopic severity score obtained by CCE-2 was comparable with conventional colonoscopy.

P238 Feasibility of the second-generation colon capsule endoscopy in patients with ulcerative colitis with a reduced preparation regimen

P238 Feasibility of the second-generation colon capsule endoscopy in patients with ulcerative colitis with a reduced preparation regimen

P239 Faecal lactoferrin and calprotectin level in fistulizing and non fistulizing Crohn's disease

P238 Feasibility of the second-generation colon capsule endoscopy in patients with ulcerative colitis with a reduced preparation regimen T. Kobayashi1,2,3 *, N. Hosoe2, K. Matsuoka3, M. Naganuma2, M. Nakano1, Y. Ishibashi3, K. Kimura3, K. Yoneno3, S. Usui3, K. Kashiwagi2, T. Hisamatsu3, N. Inoue2, H. Serizawa1, N. Watanabe1, T. Kanai3, H. Imaeda4, T. Hibi3, H. Ogata2. 1Kitasato University Kitasato Institute Hospital, Inflammatory Bowel Disease Center, Tokyo, Japan, 2Keio University, Center for Diagnostic and Therapeutic Endoscopy, Tokyo, Japan, 3Keio University, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokyo, Japan, 4Department of General Internal Medicine, Saitama Medical University, Saitama, Japan