PillCam Colon Capsule Endoscopy Research Articles

Diagnostic yield of colon capsule endoscopy for Crohn\u2019s disease lesions in the whole gastrointestinal tract

BackgroundCrohn’s disease (CD) can involve the upper gastrointestinal (GI) tract as well as the small and large bowel. PillCam colon capsule endoscopy (PCCE-2) enables observation of the whole GI tract, but its diagnostic yield for CD lesions in the whole GI tract remains unknown.AimTo elucidate the diagnostic yield of PCCE-2 in patients with CD.MethodsPatients with CD who underwent PCCE-2 and double-balloon endoscopy (DBE) using oral and anal approaches were evaluated for CD lesions in the whole GI tract. We divided the small bowel into three segments (jejunum, ileum, and terminal ileum), and the large bowel into four segments (right colon, transverse colon, left colon, rectum). Detection of ulcer scars, erosion, ulcers, bamboo joint-like appearance, and notch-like appearance was assessed in each segment. The diagnostic yield of PCCE-2 was analyzed based on the DBE results as the gold standard.ResultsOf the total 124 segments, the sensitivities of PCCE-2 for ulcer scars, erosion, and ulcers were 83.3%, 93.8%, and 88.5%, respectively, and the specificities were 76.0%, 78.3%, and 81.6%, respectively. For the 60 small bowel segments, the sensitivities were 84.2%, 95.5%, and 90.0%, respectively, and the specificities were 63.4%, 86.8%, and 87.5%, respectively. For the 64 large bowel segments, the sensitivities were 80.0%, 90.0%, and 83.3%, respectively, and the specificities were 84.7%, 72.2%, and 77.6%, respectively.ConclusionPCCE-2 provides a high diagnostic yield for lesions in the whole GI tract of patients with CD. Thus, we recommend its use as a pan-enteric tool in clinical settings.

Sa1233 The Clinical Applications of the Pillcam Colon Capsule Endoscopy: A Single Centre Experience

Sa1233 The Clinical Applications of the Pillcam Colon Capsule Endoscopy: A Single Centre Experience

PillCam colon capsule endoscopy (PCCE) in colonic diseases.

Diseases affecting the colon are common worldwide and can cause a major health problem. Colorectal cancer (CRC) as well as Inflammatory bowel diseases represent a major cause of morbidity and mortality in western countries. PillCam colon capsule endoscopy (PCCE) is a novel and promising technology that can be useful for the screening and monitoring of colonic diseases. In the recent years many articles examined the use of various versions of PCCE-the 1st and 2nd generation versus various other endoscopic or radiologic modalities both for detection of colonic polyps or cancer and in both ulcerative colitis (UC) and Crohn's disease. The aim of the current review is to provide up to date information regarding the use and usefulness of this method in these disease.

Wireless capsule endoscopy of the large intestine: a review with future projections.

Video capsule endoscopy, which was initially developed for exploring the small bowel, has been adapted for investigating the colon. This review summarizes recent developments in colon capsule technology as well as indications for its use. Second-generation PillCam colon capsule endoscopy (CCE-2) has been recently developed and has significantly improved the sensitivity and specificity of colon capsules for detecting polyps and/or tumors in patients with suspected or known colonic lesions. The use of CCE-2 has been shown to be of value in patients with incomplete standard colonoscopy. The use of CCE-2 has also been investigated in patients with ulcerative colitis and in outpatient settings. Several trials have tried to simplify the colon preparation regimen. Colon capsule endoscopy is a novel technique for exploring the colon. CCE-2 has improved the diagnostic capability of this noninvasive method. There is still room for improvement and simplification of colon preparation regimens. Apart from detection of polyps or neoplasms, colon capsule endoscopy has also been assessed in patients with inflammatory bowel disease.

Tu1148 Role of Prucalopride (Resolor®) in the Setting-Up of PillCam Colon-Capsule Endoscopy (CCE). Experience From a Single Centre

Tu1148 Role of Prucalopride (Resolor®) in the Setting-Up of PillCam Colon-Capsule Endoscopy (CCE). Experience From a Single Centre

Colon capsule endoscopy: What we know and what we would like to know.

Colonoscopy is usually perceived as an invasive and potentially painful procedure, being also affected by a small, but definite, risk of major complications (cardiopulmonary complications, perforation, hemorrhage) and even mortality. To improve both acceptability and safety, PillCam Colon Capsule Endoscopy (CCE) (Given Imaging Ltd, Yoqneam, Israel) has been developed. CCE represents a non-invasive technique that is able to explore the colon without sedation and air insufflation. The Second Generation of Colon Capsule Endoscopy (PillCam Colon 2) (CCE-2) was proven to be an accurate tool to detect colonic neoplastic lesions when used in average risk individuals. To date, the evidence supports the use of CCE-2 in case of colonoscopy failure, in patients unwilling to perform colonoscopy and when colonoscopy is contraindicated. Other potential applications, such as colorectal cancer screening or diagnostic surveillance of inflammatory bowel disease need to be clarified. In this paper, the current "state of the art", potential application of CCE and future needs are evaluated.

PillCam colon capsule endoscopy versus conventional colonoscopy for the detection of severity and extent of ulcerative colitis

To evaluate PillCam colon capsule endoscopy (PCCE) in detecting the severity and extent of active ulcerative colitis (UC), in comparison with conventional endoscopy. From July 2009 to June 2012, patients with confirmed UC were enrolled in this prospective single-center study. After they had undergone the PCCE, they received a conventional colonoscopy. The extent of mucosal damage and inflammatory lesions during both procedures was recorded for comparison. In addition, the regimen of bowel preparation, completion rate, colonic cleansing, compliance or adverse events were analyzed. A total of 26 patients was consecutively included, among whom one was withdrawn. The remaining 25 (nine females and 16 males with a mean age of 44.2 years) completed the study. There was significant correlation in the severity (κ = 0.751, P < 0.001) and extent (κ = 0.522, P < 0.001) of UC between the PCCE and conventional colonoscopy. In addition, the excellent to good rate of colonic cleanliness in PCCE was 80%. There were no remarkable adverse events during the study. PCCE provides an outstanding performance in the detection of the severity and extent of active UC.

Kolonkapselendoskopie: Leitlinie der Europäischen Gesellschaft für Gastrointestinale Endoskopie

Die Pillcam-Kolonkapselendoskopie (CCE) ist eine innovative, nicht invasive peroral applizierbare Kapseltechnik, die die Untersuchung des Kolons ohne Sedierung und Gasinsufflation ermöglicht. Obwohl sie in Europa und anderen Ländern bereits verfügbar ist, sind die klinischen Indikationen der CCE, die Befundung und das Vorgehen bei detektierten Veränderungen bisher nicht standardisiert. Das Ziel dieser evidenzbasierten, konsensuellen Leitlinie, die von der Europäischen Gesellschaft für Gastrointestinale Endoskopie (ESGE) in Auftrag gegeben worden ist, ist es, Anbieter im Gesundheitssystem mit einem umfassenden Rahmen für die potenzielle Implementierung dieser Technik in klinische Abläufe auszustatten.

Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

PillCam colon capsule endoscopy (CCE) is an innovative noninvasive, and painless ingestible capsule technique that allows exploration of the colon without the need for sedation and gas insufflation. Although it is already available in European and other countries, the clinical indications for CCE as well as the reporting and work-up of detected findings have not yet been standardized. The aim of this evidence-based and consensus-based guideline, commissioned by the European Society of Gastrointestinal Endoscopy (ESGE) is to furnish healthcare providers with a comprehensive framework for potential implementation of this technique in a clinical setting.

Accuracy and safety of second-generation PillCam COLON capsule for colorectal polyp detection

PillCam COLON capsule endoscopy (CCE) (Given Imaging Ltd, Yoqneam, Israel) is one of the most recent diagnostic, endoscopic technologies designed to explore the colon. CCE is a noninvasive, patient-friendly technique that is able to explore the colon without requiring sedation and air insufflation. The first generation of CCE was released onto the market in 2006 and although it generated great enthusiasm, it showed suboptimal accuracy. Recently, a second-generation system (PillCam COLON 2) (CCE-2) has been developed to increase sensitivity for colorectal polyp detection. In this review, accuracy and safety data for CCE-2 are analyzed.

PillCam® Colon Capsule is an Effective Tool in Management of Patients With Suspected or Known Inflammatory Bowel Disease: Preliminary Results From a UK Tertiary Care Centre

Introduction PillCam Colon capsule endoscopy (CCE) is a relatively new technique for imaging the colon. Its role in patients with inflammatory bowel disease (IBD) has not been fully explored. A recent European multicentre trial has shown that PillCam reactivated in the small bowel (SB) in about 98% of patients. Ileocolonic mucosal visualisation thus achieved by CCE may be a potential strategy in assessment of patients with known or suspected IBD. Methods Consecutive patients with proven or suspected IBD were included in the study. The CCE was performed as per standard protocol (with PEG and sodium phosphate as laxative agents). Patient demographics, clinical presentation and indication for CCE as well as nature and location of the findings, colonic transit time, complications and clinical implications of the findings, were analysed. Bowel cleanliness was described using a 4 point validated scale (1 – excellent, 2 – good, 3 – fair, 4 – poor). Data was expressed as median and IQR. Results 29 patients (86.2% females) with proven (n=10) or suspected IBD (n=19) underwent CCE between October 2007 and 2010. 41.4% of all patients had refused colonoscopy; 31% had a failed attempt while the rest were offered CCE as the initial imaging test. Median age was 44 (IQR 29–55.5) years. PillCam colon 1 and 2 were respectively used in 26 (89.7%) and 3 (11.3%) patients. CCE failed in 2 (6.9%) patients, all in the known IBD patients. Complete colonic mucosal visualisation was noted in 62.1% of all patients. 8 of patients with IBD had Crohn9s disease (CD) (n=4 Crohn9s colitis, n=3 both small (SB) and large bowel disease, n=1, only SB disease) while 2 had ulcerative colitis. 3 patients with CD had previously undergone surgery. The predominant indication was assessment of disease activity. In patients who had a successful test, mucosal visualisation enabled adequate assessment of disease activity in all (100%), thus guiding effective therapy. In suspected IBD patients, majority had diarrhoea (100%) and abdominal pain (63.2%). Pathology was detected in 63.2% of patients. SB Crohn9s was diagnosed in 4 (21.1%) patients while proctitis was noted in 1 (5.3%). Other significant findings included non-steroidal anti-inflammatory medication related injury (5.3%), colonic polyps (10.5%), angioectasia (21.1%) and diverticular disease (26.3%). Capsule transit times in the SB and colon were 71 (IQR 47–136) and 80 (IQR 48.5–216.5) min respectively; bowel cleanliness was 2 (IQR 2–3)). Conclusion In patients with proven or suspected IBD, CCE is an effective investigation modality. Its strengths lie in its minimally invasive nature coupled with its ability to assess disease activity thus guiding treatment strategies in most cases.

Mo1529 Comparison of 3 Different Colon Cleansing Regimens for Patients Candidate to PillCam Colon Capsule Endoscopy (CCE)

Mo1529 Comparison of 3 Different Colon Cleansing Regimens for Patients Candidate to PillCam Colon Capsule Endoscopy (CCE)

PillCam COLON capsule endoscopy: recent advances and new insights

Capsule endoscopy for the colon was introduced to allow an alternative screening method to the invasive classic colonoscopy. The results of initial studies have shown inferior detection rates of colonic polyps by the colon capsule. In this paper we aim to review and summarize the recent advances in wireless capsule endoscopy of the colon. Publications regarding the use of colon capsule with new technology, as well as personal experience, were reviewed. Since the introduction of the first generation of the colon capsule, many improvements have been made to create a better capsule endoscope. These include a wider angle of view, a faster adaptable frame rate and a new data recorder which is able to control the capsule activity during the transit through the bowel. Recent studies show these improvements had a direct effect on the colon capsule performance, leading to a better diagnostic yield. Recent advancements in the technology of the wireless colon capsule endoscope offer the option to screen patients for colonic polyps noninvasively. Colon capsule endoscopy may become relevant for assessment of extent of inflammatory bowel disease.

PillCam© Colon Capsule for the study of colonic pathology in clinical practice: Study of agreement with colonoscopy

several studies have pointed out the effectiveness of the PillCam colon capsule endoscopy (CCE) compared with the colonoscopy in the study of the colonic pathology. the objective of our study was to assess the agreement in the diagnosis of CCE with conventional colonoscopy as well as its sensitivity and specificity, and to describe the findings of the CCE in our clinical practice. Consecutive patients with abdominal symptoms were included in the study. The CCE was performed as previously reported (with PEG and sodium phosphate as laxative agents). The nature and location of the findings, colonic transit time, complications, cleanliness degree and consistency with diagnostic colonoscopy, when performed, were analyzed. a total of 144 subjects (67 women and 77 men); (52.17 ± 16.71 years) with the following indications were included: screening of Colorectal cancer (88 patients), control after polipectomy (24), incomplete colonoscopy (7), rectal bleeding (10), anemia (8), diarrhea (7). The CCE exploration was complete in 134/144 cases (93%), with no case of retention. The preparation was good-very good in 88/134 (65,6%), fair in 26/134 (19,4%) and poor in 20/134 (15%) of the cases. The average colonic transit was of 140.76 min (9-603). Any adverse effect was notified.In 44 cases a colonoscopy was carried out after CCE (results were hidden from another endoscopist). Compared to colonoscopy, the rate of agreement was 75,6%, the sensitivity was 84% and the specificity 62,5%, PPV was 77,7% and NPV was 71,4%.The colonic findings in 134 CCE were: in 34 cases CCE it did not show lesions, diverticulosis in 63 explorations, polyps in 43, angiodysplasias in 15, Crohn's Disease in 9 and ulcerative colitis in other 8 cases. the CCE is an effective and reliable technique for the detection of lesions in colon, and because of its high agreement with the colonoscopy, it could be useful in clinical practice. Further studies with large seria and cost-effectiveness analysis are needed to confirm these data.

PillCam Colon Capsule Endoscopy

Aim of this study is to assess the feasibility of substituting sodium phosphate (NaP) with polyethylene glycol (PEG)-boosters in the protocol preparation for PillCam Colon Capsule Endoscopy (CCE). CCE represents a new diagnostic, endoscopic technology for colonic exploration. Bowel preparation for CCE is necessary not only to clean the colon, but also to promote capsule propulsion. For this reason, NaP boosters have been added to a 4 L PEG-preparation. NaP has been recently related with major side-effects. Forty patients were prospectively randomized to Standard (n=20) or Modified (n=20) regimen. Standard regimen included clear liquid diet, 4 L of PEG, and 1 or 2 NaP boosters. In the Modified regimen, NaP boosters were substituted by 1 or 2 PEG boosters; 4 senna tablets and a low-residue diet were also included. Patients underwent CCE and conventional colonoscopy, carried out on the same day. CCE excretion rate, colon transit time, colon cleansing, and accuracy were evaluated. Hundred percent and 75% of CCE were excreted with the Standard and Modified regimen, respectively (P=0.02). Mean±SE colonic transit time of capsule was 2.17±1.43 hours in the Standard group, and 5.32±2.53 hours in the Modified group (P<0.001). Adequate preparation was achieved in 42.5% of the cases, without statistically significant difference between the 2 groups (35% vs. 53%; P=NS). CCE sensitivity and specificity for ≥6 mm polyps were 63% and 87%, without difference between the 2 groups. The exclusion of NaP booster from CCE preparation resulted into a clinically meaningful reduction of the capsule excretion rate that was only partially compensated by the PEG booster.

A new regimen of bowel preparation for PillCam colon capsule endoscopy: A pilot study

Background Colon capsule endoscopy (CCE) represents a new diagnostic, endoscopic technology for colonic exploration. Current protocols of preparation led to discordant rates of adequate cleansing level or CCE excretion. Aim To evaluate the effect of a new regimen of bowel preparation for CCE on colon cleansing levels and on rate of capsule excretion. Study 60 patients were prospectively enrolled. The new regimen of preparation consisted of a split regimen of PEG administration and of a 45 mL dose of sodium phosphate (NaP). Four senna tablets and a low-residue diet were also included. CCE excretion rate, colon cleansing, and accuracy were assessed. Results Forty-six patients were included in the final analysis, 13 patients (22%) being excluded because of preparation protocol deviations and one due to CCE technical failure (2%). At CCE, bowel preparation was rated as good in 78% of patients, fair in 20% and poor in 2%. CCE excretion rate occurred in 83% of patients. CCE sensitivity and specificity for significant findings was 100% and 95%, respectively. Conclusions The combination of a split-dose of PEG solution with a low dose of NaP boosters resulted in high rates of adequate cleansing level and CCE excretion.

S1596: PillCam Colon Capsule Endoscopy (PCCE): The Quality of Preparation Makes the Difference!

S1596: PillCam Colon Capsule Endoscopy (PCCE): The Quality of Preparation Makes the Difference!

S1595: PillCam Colon Capsule Endoscopy (PCCE) for Colon Exploration: A Single Centre Italian Experience

S1595: PillCam Colon Capsule Endoscopy (PCCE) for Colon Exploration: A Single Centre Italian Experience

Preparations for PillCam Colon Capsule Endoscopy Are As Acceptable and Safe As That for Standard Colonoscopy

Background: PillCam Colon Capsule Endoscopy (PCCE) is an emerging non-invasive method to explore the colon. The preparation (prep) for PCCE lasts longer than that for standard colonoscopy (SC) and requires additional laxatives as it should clean the colon and also facilitate the progression of the capsule. Concerns arise because the large volume of liquids required for PPCE prep may decrease the compliance to the procedure. Aims: Aim of this study was to compare the satisfaction between patients (pts) who received 2 different PCCE regimens with those who received SC regimen.

Is PillCam COLON Capsule Endoscopy Ready for Colorectal Cancer Screening? A Prospective Feasibility Study in a Community Gastroenterology Practice

Colorectal cancer (CRC) screening with colonoscopy was introduced into the National Cancer Prevention Program in Germany in 2002. As compliance for screening is low (around 3% per year), colon capsule endoscopy (CCE) could be an alternative approach. In this study, feasibility and performance of CCE were evaluated in comparison with colonoscopy in ambulatory patients with special attention to a short colon transit time. CCE was prospectively tested in ambulatory patients enrolled for colonoscopy who presented for screening or with positive fecal occult blood test. Study subjects underwent colon preparation and ingested the capsule in the morning. Colonoscopy was performed after excretion of the capsule. Colonoscopy and CCE were performed by independent physicians who were blinded to the results. In total, 38 patients were included. One patient was excluded because the capsule remained in the stomach during the entire period of examination. Another patient had limited time and the procedure had to be stopped when the capsule was still in the transverse colon. We therefore report the results of 36 patients (30 men and 6 women; mean age 56 years, range 23-73 years) who successfully completed CCE and the conventional colonoscopy examination. The capsule was excreted within 6 h in 84% of the patients (median transit time 4.5 h). If oral sodium phosphate was excluded from the preparation, the colon transit time increased to a median of 8.25 h. In total, 7 of 11 small polyps (<6 mm) detected by colonoscopy were identified by CCE. One small polyp detected by CCE was not identified by colonoscopy. In this series, no large polyps were found. One CRC was detected by both methods. The mean rates of colon cleanliness (range from 1=excellent to 4=poor) in the cecum (2.1), transverse colon (1.6), and in the descending colon (1.5) were significantly better than in the rectosigmoid colon (2.6), and the overall mean rate during colonoscopy was significantly better than during CCE. No adverse effects occurred. CCE appears to be a promising new modality for colonic evaluation and may increase compliance with CRC screening. To achieve a short colon transit time, sodium phosphate seems to be a necessary adjunct during preparation. The short transit time is a prerequisite to abandon the delay mode of the capsule. With an undelayed PillCam COLON capsule, a "pan-enteric" examination of the gastrointestinal tract would be possible. Further studies are needed to improve the cleanliness, especially in the rectum and to evaluate the method as a potential screening tool.