PillCam Colon Research Articles

TOP 100 and detection of colorectal lesions in colon capsule endoscopy: more than meets the eye.

Colon capsule endoscopy (CCE) is a well-known method for the detection of colorectal lesions. Nevertheless, there are no studies reporting the accuracy of TOP 100, a CCE software tool, for the automatic detection of colorectal lesions in CCE. We aimed to evaluate the performance of TOP 100 in detecting colorectal lesions in patients submitted to CCE for incomplete colonoscopy compared with classic reading. A retrospective cohort study including adult patients submitted to CCE (PillCam COLON 2; Medtronic) for incomplete colonoscopy. Blinded for each other's evaluation, one experienced reader analyzed the TOP 100 images and the other performed classic reading to identify colorectal lesions. Detection of colorectal lesions, namely polyps, angioectasia, blood, diverticula, erosions/ulcers, neoplasia, and subepithelial lesions was assessed and TOP 100 performance was evaluated compared with the gold standard (classic reading). A total of 188 CCEs were included. Prevalence of colorectal lesions, polyps, angioectasia, blood, diverticula, erosions/ulcers, neoplasia, and subepithelial lesions were 77.7, 54.3, 8.5, 1.6, 50.0, 0.5, 0.5, and 1.1%, respectively. TOP 100 had a sensitivity of 92.5%, specificity of 69.1%, negative predictive value of 72.5%, positive predictive value of 91.2%, and accuracy of 87.2% for detecting colorectal lesions. TOP 100 had a sensitivity of 89.2%, specificity of 84.9%, negative predictive value of 86.9%, positive predictive value of 87.5%, and accuracy of 87.2% in detecting polyps. All colorectal lesions other than polyps were identified with 100% accuracy by TOP 100. TOP 100 has been shown to be a simple and useful tool in assisting the reader in the prompt identification of colorectal lesions in CCE.

High diagnostic yield despite a lower completion rates for inpatient versus outpatient colon and pan-intestinal capsule endoscopy: a nested case-control study

BackgroundIncreased familiarity with capsule endoscopy (CE) has been associated with a growing demand for urgent inpatient procedures. Limited data exists comparing the effect of admission status on colon capsule (CCE) and pan-intestinal capsule (PIC) performance. We aimed to compare the quality of inpatient versus outpatient CCE and PIC studies.MethodsA retrospective nested case-control study. Patients were identified from a CE database. PillCam Colon 2 Capsules with standard bowel preparation and booster regimen were used in all studies. Basic demographics and key outcome measures were documented from procedure reports and hospital patient records, and compared between groups.Results105 subjects were included, 35 cases and 70 controls. Cases were older, were more frequently referred with active bleeding and had more PICs. The diagnostic yield was high at 77% and was similar in both groups. Completion rates were significantly better for outpatients, 43% (n = 15) v’s 71% (n = 50), OR 3, NN3. Neither gender nor age affected completion rates. Completion rates and preparation quality were similar for CCE and PIC inpatient procedures.ConclusionInpatient CCE and PIC have a clinical role. There is an increased risk of incomplete transit in inpatients, and strategies to mitigate against this are needed.

Single or double headed capsules for the investigation of suspected small bowel bleeding: Are two heads better than one

BackgroundCapsule endoscopy is now the accepted first line investigation for suspected small bowel (SB) bleeding. Recent evidence suggests the diagnostic yield for SB pathology may be higher for tailored double headed (DH) SB capsules. Whether other forms of bidirectional capsules offer a similar advantage is less clear.AimTo compare the efficacy of single headed versus bidirectional capsules in detecting pathology in patients with suspected small bowel bleeding.MethodsA single centre prospective comparison study was conducted over an 8 month period in a tertiary care hospital. Patients referred with overt or suspected SB bleeding were assigned to either SB3 Medtronic SB capsule (SH) during the initial four months or PillCam Colon 2 Medtronic capsule (DH) during the subsequent four months. Studies were analysed by trained Capsule Endoscopists and approved by our institutions capsule review board. Findings were compared between SH and DH capsules using a chi2 or t-test as appropriate. A p value of <0.05 was considered significant.Results201 subjects were included, mean age 61.8 years, 90 (45%) male. Majority referred with occult bleeding, 153 (76%). DH and SH capsule used in 100 and 101 cases, respectively. 90% (n=181) capsules were complete and overall diagnostic yield was 57% (n=114). Diagnostic yield was similar between both groups - DH 53% (n=53), SH 60% (n=61). Positive finding in overt bleeding; SH 85% (n=22) versus DH 50% (n=11), p<0.02. SH capsules more frequently detected SB inflammation, 27 (27%) versus 9 (9%), p<0.002. More patients had another diagnosis in the DH (19) than the SH (9), p<0.04, the majority were type 1a vascular lesions, “red spots” or diminutive colonic polyps.ConclusionSingle head and double head capsules perform similary in terms of diagnostic yield overall. This supports the continued use of standard small bowel capsules for investigation of the small bowel.

Colon Capsule Endoscopy in the Assessment of Mucosal Healing in Crohn's Disease.

BackgroundPatients with Crohn’s disease (CD) undergo frequent endoscopic procedures, with visualization of the gastrointestinal mucosa central to treatment decision-making. Subsequently, a noninvasive alternative to optical colonoscopy (OC) would be welcomed. One such technology is capsule endoscopy, including the PillCam COLON 2 (PCC2), though research validating its use in ileocolonic CD is limited. This study aims to compare PCC2 with ileocolonoscopy (OC) in assessing mucosal CD through use of a standardized scoring system.MethodsAt an Australian tertiary hospital, same-day PCC2 and ileocolonoscopy results of 47 CD patients, with known nonstricturing disease, were prospectively collected and analyzed for correlation and agreement. Deidentified recordings were reported by a single expert gastroenterologist. Mucosal disease was quantified using the Simple Endoscopic Score for Crohn’s Disease (SES-CD). The SES-CD results of paired endoscopic modalities were compared in total per bowel segment and per SES-CD variable.ResultsOf 47 PCC2 recordings, 68% were complete, fully assessing terminal ileum to rectum, and OC was complete in 89%. Correlation (r) between total SES-CD scores was strongest in the terminal ileum (r = 0.77, P < .001), with the SES-CD variable of “ulcer detection” showing the strongest agreement. The PCC2 (vs OC) identified additional ulcers in the terminal ileum; ascending, transverse, and descending colon; and rectum; scores were 5 (1), 5 (3), 1 (1), 2 (1), and 2 (2), respectively.ConclusionsThe PCC2 shows promise in assessing ileocolonic mucosa, especially in proximal bowel segments, with greater reach of visualization in the small bowel. Given the resource and safety considerations raised by the Coronavirus disease 2019 pandemic, capsule endoscopy has particular significance.This article aims to contribute to the limited body of research surrounding the validity of capsule endoscopy technology in assessing ileocolonic mucosa in Crohn’s Disease patients. In doing so, an alternative option for patients enduring frequent endoscopies is given potential.

P188 Artificial Intelligence and Colon Capsule Endoscopy: Automatic detection of colonic mucosal lesions and blood using a convolutional neural network

Abstract Background Conventional colonoscopy is the standard criterion for the diagnosis and staging of colonic disease, including inflammatory bowel disease (IBD). However, it has the risk of complications, including bleeding and perforation. Colon capsule endoscopy (CCE) is a minimally invasive alternative for patients refusing conventional colonoscopy or for whom the latter is contraindicated. However, reading CCE images is a time-consuming task and prone to diagnostic error. Detection of colonic blood is relevant for the diagnosis and assessment of the activity of IBD, particularly ulcerative colitis. An accurate and early diagnosis is essential as it directs subsequent treatment. Our aim was to develop an Artificial Intelligence (AI) algorithm, based on a multilayer Convolutional Neural Network (CNN), for automatic detection of blood and other significant lesions in the colonic lumen in CCE exams: Methods A total of 24 CCE exams (PillCam COLON 2®) from a single centre, performed between 2010–2020, were analysed. From these exams 7640 images (2915 normal mucosa, 3065 blood and 1660 mucosal lesions) were ultimately extracted. Two image datasets were created for CNN training and testing. These images were inserted in a CNN model with transfer of learning. The output provided by the CNN was compared to the classification provided by a consensus of specialists (Figure 1). Performance marks included sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), accuracy and area under the receiving operator characteristics curve (AUROC). Results Blood was detected with a sensitivity and specificity of 97.2% and 99.9%, respectively. The AUROC for detection of blood was 1.00 (Figure 2). Detection of other findings had a sensitivity and specificity of 83.7% and 96.7%, respectively. The overall accuracy of the CNN was of 95.4%. Figure 1 - Output obtained from the application of the convolutional neural network. N: normal mucosa; B - blood or hematic residues; ML – mucosal lesions. Figure 2 – Receiver operating characteristic analyses of the network’s performance in the detection of normal mucosa, blood and colon mucosal lesions. AUROC – are under the receiver operating characteristic curve; N – normal colonic mucosa; B – blood; ML – mucosal lesions. Conclusion We developed a pioneer CNN for CCE which demonstrated high levels of efficiency for the automatic detection of blood and lesions with high clinical significance. The development of tools for automatic detection of these lesions may allow for minimization of diagnostic error and the time spent evaluating these exams.

P113 Automatic detection of colonic ulcers and erosions in colon capsule endoscopy images using a convolutional neural network

Abstract Background Conventional colonoscopy is gold standard for the diagnosis and monitoring of patients with suspected or known inflammatory bowel disease (IBD). Nevertheless, it is a potentially painful procedure with risk of complications, including bleeding and perforation. Colon capsule endoscopy (CCE) is a minimally invasive alternative for patients unwilling to undergo colonoscopy or when it is contraindicated or unfeasible. However, CCE produces thousands of frames and their revision is a time-consuming and monotonous task. The detection of ulcers and erosions is paramount for the diagnosis and assessment of the activity of IBD. However, these lesions may appear in a very small number of frames, thus increasing the risk of overlooking significant lesions. Our aim was to develop an Artificial Intelligence (AI) algorithm, based on a multilayer Convolutional Neural Network (CNN) for automatic detection of ulcers and erosions in CCE exams. Methods A total of 24 CCE exams (PillCam COLON 2®) performed at a single centre between 2010–2020 were analysed. From these exams, 3 635 frames of the colonic mucosa were extracted, 770 containing colonic ulcers or erosions and 2 865 showing normal colonic mucosa. These images were used for construction of training (80% of the frames) and validation (20% of the frames) datasets. For automatic identification of these lesions, these images were inputted in a CNN model with transfer learning. The output provided by the CNN (Figure 1) was compared to the classification provided by a consensus of specialists. Performance marks included sensitivity, specificity, positive and negative predictive values, accuracy and area under the receiving operator characteristics curve (AUROC). Results After the optimization of the neural architecture of the CNN, our model automatically detected colonic ulcers and erosions with a sensitivity of 90.3%, specificity of 98.8% and an accuracy of 97.0% (Figure 2). The AUROC was 0.99 (Figure 3). The mean processing time for the validation dataset was 11s (approximately 66 frames/s). Conclusion We developed a CNN model which demonstrated high levels of efficiency for the automatic detection of ulcers and erosions in CCE images. Our study lays the foundations for the development of effective AI tools for application to CCE exams. These systems may enhance the diagnostic accuracy and reading efficiency of CCE, thus expanding the role of minimally-invasive colonic exploration in the management of IBD patients.

P353 Pan-enteric capsule endoscopy enables assessment of mucosal healing after biologic treatment initiation in Crohn’s disease

Abstract Background Pan-enteric capsule endoscopy (pan-CE) visualizes the entire gastrointestinal tract and provides an attractive alternative to conventional ileocolonoscopy to evaluate luminal disease activity in Crohn’s disease (CD). An earlier study showed that pan-CE is feasible, safe and well tolerated by CD patients. The aim of the present study was to assess the Sensitivity TO measure Change (STOC) in mucosal disease activity using pan-CE in CD. Methods Patients with CD and active disease based on symptoms (i.e. Crohn’s disease activity index (CDAI) &amp;gt;150) and inflammatory biomarkers (i.e. C-reactive protein (CRP) &amp;gt;5 mg/L and/or fecal calprotectin (fCal) levels &amp;gt;250 mg/kg) underwent pan-CE, using the second-generation Pillcam colon capsule, prior to and 8-12 weeks after treatment initiation with infliximab, adalimumab or vedolizumab. Luminal disease activity was assessed using the Crohn’s disease endoscopic index of severity (CDEIS) and the simple endoscopic score for Crohn’s disease (SES-CD), expanded with two segments for the jejunum and pre-terminal ileum. Sensitivity to detect mucosal change was assumed if the standardized effect size was &amp;gt;0.8. Correlations between the evolution in CDAI, CRP and fCal with endoscopic activity scores before and after treatment initiation were calculated. Results Twenty-eight patients underwent pan-CE of whom two withdrew consent and four did not start biologic therapy. Twenty-two patients (78.6%) started biologic treatment and underwent pan-CE twice. Median duration between treatment initiation and pan-CE was 11 weeks (IQR: 9.8-12 weeks). Half of patients (11/22) were female and the median age was 24 years (IQR=22-38 years). The standardized effect size was 1.11 for CDEIS and 1.36 for SES-CD. Median CDEIS scores decreased from 6.8 (IQR=4.6-11.2) to 3 (IQR=0.9-6.0, p=0.01). Median SES-CD scores decreased from 15.5 (IQR=9.8-22.5) to 6 (IQR=2.8-11.3, p=0.001). SES-CD score per segment decreased significantly for colon segments, not for small bowel segments (figure 1). The difference in CDAI, CRP and fCal outcomes before and after treatment did not correlate with the change in CDEIS and SES-CD. Conclusion Pan-CE is useful to assess luminal disease activity in CD patients who embark on biological treatment. Pan-CE is sensitive to monitor mucosal healing outcomes and might therefore replace ileocolonoscopy for this indication in CD patients.

A new panenteric capsule endoscopy-based strategy in patients with melena and a negative upper gastrointestinal endoscopy: a prospective feasibility study.

patients presenting with melena and nondiagnostic esophagogastroduodenoscopy are usually investigated with colonoscopy and if negative, with small bowel capsule endoscopy. In this pilot study, we tested feasibility and performance of panenteric capsule endoscopy (PCE) in patients presenting with melena and negative esophagogastroduodenoscopy. Between January and December 2018, consecutive patients presenting with melena, clinically significant bleeding and negative esophagogastroduodenoscopy were invited to undergo PCE by swallowing PillCam Colon 2 (Medtronic Inc., Dublin, Ireland). PCE results, further diagnostic or therapeutic examinations, rebleeding rates at 30 days and 12 months were recorded. Out of 128 patients with melena, 23 had negative esophagogastroduodenoscopy. Of them, 12 (8 female, mean age 76 years) underwent PCE, which allowed complete small bowel and colonic evaluation in 12 (100%) and 11 (91.7%) patients, respectively. The small bowel and colon cleansing were adequate in 100 and 83.3%, respectively. No PCE-related complications were observed. The PCE diagnostic yield was 83.3%: significant findings were located in the small bowel, colon or both in 5 (41.7%), 4 (33.3%) and 1 (8.3%) patients, respectively. Device-assisted enteroscopy was performed in 6 (50%) patients. Thirty days and 1 year rebleeding rates were 0 and 18.1%, respectively. In this proof-of-concept study, PCE was feasible and safe in patients with melena and negative esophagogastroduodenoscopy, identifying the bleeding site in 83% of patients. PCE lead to small bowel therapeutic interventions in 50% of patients, thus avoiding unnecessary standard colonoscopy. Further large prospective randomized studies investigating this strategy are warranted.

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.

A pilot study for using high-volume colon irrigation bowel preparation for colon capsule endoscopy shows feasibility of adequate bowel prep with high patient satisfaction

A feasibility study was performed to test a bowel preparation (BP) method that would improve patients’ experience of colon capsule endoscope (CCE) while retaining clinical adequacy. Specifically, the use of high-volume colon irrigation with the Hygieacare® System, HygiPrep™, was tested in conjunction with Medtronic’s PillCam COLON 2 Capsule. This prospective, single-center, and IRB-approved study evaluated HygiPrep use prior to the PillCam COLON 2 procedure instead of the standard split-polyethylene glycol-electrolyte (PEG) oral prep. The study was performed at Austin Gastroenterology (Austin, TX), and all capsule video files were forwarded to a Central Reader to evaluate and compile a study report. Six of the seven (86%) subjects completed both the HygiPrep and PillCam COLON 2 exams and were graded as excellent, good, or adequate by the Central Reader. Patients’ feedback reported positive satisfaction scores for both the HygiPrep and the PillCam COLON 2 procedures. These results support our hypothesis that HygiPrep was as effective as Split-PEG BP. We suggest that the HygiPrep, is a suitable BP for CCE, providing adequate BP and high patient satisfaction.

P156 Interobserver variation of visual assessment vs. measuring ulcer size in Crohn’s disease using the RAPID9 Software in PillCam COLON2

Abstract Background Ulcer size is important when assessing mucosal healing in Crohn’s disease (CD) and commonly assessed with visual estimation. There is a new built-in measurement tool in the RAPID9 reader software used in colon capsule endoscopy (CCE). We aimed to assess the agreement between visually estimating ulcer size vs. using the estimation tool and the interobserver agreement for both methods independently using PillCam Colon studies in patients with Crohn’s disease. Methods 7 experts of PillCam readers were recruited to assess CCE in this study. 7 CCE recordings were thumbnailed for the presence of ulcers. A total of 43 ulcers were consecutively selected for this study. The readers were provided with an instruction manual which specified that they were to first visually estimate the ulcer and then subsequently measure the ulcer with the size estimation tool in RAPID9 software. Two measurements were taken, A – longest distance of the ulcer end to end, and B – longest distance that is perpendicular to A. Results were analysed using Kendall’s Coefficient of Concordance (Kendall’s W). Results When comparing visual assessment of ulcer size vs. using the estimation tool, both measurements A and B demonstrated statistically significant agreement (p of A = 0.000, p of B = 0.000; W of A=0.90, W of B=0.82). For measurement A, our results demonstrated higher interobserver agreement when assessing ulcer size using the estimation tool (W=0.84) as compared with visually assessing ulcer size (W=0.80). This contrasts with measurement B where there was higher interobserver agreement when visually assessing ulcer size (W=0.75) as compared with using the measurement tool (W=0.73). Nevertheless, there was no statistically significant variability amongst measurement A nor B (p = 0.000) in visual assessment and measurement tool. Conclusion The conventional visual estimation of ulcer size in CD using CCE was just as accurate as the measurement tool. Furthermore, consistency between readers was demonstrated with the high level of interobserver agreement for the measurement tool and visual estimation. This novel finding is reassuring given the decade of capsule studies done with older software, where a measurement tool was not available. Further study should be conducted to assess and consolidate the validity of the estimation tool in assessing ulceration and mucosal healing in CD with a larger number and variety of lesions studied.

Development of a computed cleansing score to assess quality of bowel preparation in colon capsule endoscopy.

Background and study aims Colon capsule endoscopy (CCE) does not possess an objective and reliable scoring system to assess the quality of visualization of the colon mucosa. The aim of this study was to establish a colonic computed assessment of cleansing (CAC) score able to discriminate “adequately cleansed” from “inadequately cleansed” CCE still frames. Patients and methods Twelve normal and complete CCEs, using the Pillcam Colon 2 system (Medtronic, Minnesota, United States), were prospectively selected amongst a database. A CAC score, defined as the ratio of color intensities red over green (R/G ratio), and red over brown (R/(R + G) ratio) was calculated for each extracted colonic frame. After sorting and random selection, two sets of still frames representative of the range of these ratios were obtained. These images were analyzed twice in random order by two experienced CCE readers who were blinded to the CAC scores. A receiver operating characteristic (ROC) curve was forged for both types of ratios and a threshold established, yielding the highest diagnostic performance in terms of adequate cleansing assessment. Results Four-hundred-and-eight frames were extracted. Regarding the R/G ratio, a threshold value of 1.55 was calculated, with a sensitivity of 86.5 % and a specificity of 77.7 %. Regarding the R/(R + G) ratio, a threshold value of 0.58 was calculated with a sensitivity of 95.5 % and a specificity of 62.9 %. Conclusion The two proposed CAC scores based on the ratio of color intensities come with high sensitivities for discriminating between “adequately cleansed” and “inadequately cleansed” CCE still frames, but they lack specificity. Further refinement, with implementation of additional image parameters, is warranted.

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

COLON CAPSULE ENDOSCOPY: POSSIBILITIES OF NON-INVASIVE DIAGNOSTICS OF COLON DISEASES

Purpose. Evaluation of feasibility of colon capsule endoscopy (CCE), as non-invasive method of diagnostics of colon abnormalities. Patients and methods. From 31.01.2014 to 10.01.2017 we successfully performed 100 CCE in 101 (99,0%) patients (m-50, f-48, mean age 44,7 ± 14,8 years, range 22–81), including 2 twins aged 8 years (CCE was performed with pediatrician). The main indication for colonoscopy was colorectal cancer screening (73 (73,0%) pts). The indication for colonoscopy to 2 twins was complicated Peutz Jeghers syndrome in one of them. CCE was performed using the system PillCam (Given Imaging) and capsule PillCam Colon 2. For the bowel preparation we used two-stage regimen; for the evaluation of preparation — J.A. Leighton scale. Results. Preparation was adequate in 88 (88,0%) pts, non-adequate — in 12 (12,0%) pts. Total CCE was performed in 82 (82,0%) patients. The mean colon transit time was 4 hours 43 min ± 3 hours15 min. Total evaluation of the colon was performed in 82 (82,0%) pts. Mucosal lesions were revealed in 75 (75,0%) pts, including epithelial polyps in 52 (69,3%) pts. We also revealed comorbid lesions in 41 (54,6%) pts. Colonoscopy after CCE was recommended to 28 (37,3%) pts because of polyp detection, sized ≥6 mm, and because of inflammatory changes of colon mucosa, but only 11 (39,3%) pts were performed colonoscopy. Conclusion. In this article the experience of colon capsule endoscopy demonstrates the principal possibility of noninvasive evaluation of the colon and detection of colon abnormalities.

Extracolonic findings with the PillCam Colon: is panendoscopy with capsule endoscopy closer?

Background and study aims: Colon capsules display images from the moment they are ingested, making the study of other extracolonic areas possible. The aim of this study was to analyze the significance of these extracolonic findings. Patients and methods: In this single-center, prospective study, 165 patients underwent colon capsule endoscopy (CCE) between September 2009 and October 2012 to rule out colonic pathology. Images were recorded, without interruptions, from the moment the capsule was ingested until its battery ran out. The study was deemed complete when the capsule had traveled from the esophagus to excretion or until the hemorrhoidal plexus was observed. Results: CCE was used for colorectal cancer (CRC) screening (81.2 %), to investigate for chronic diarrhea (9.7 %) and chronic iron deficiency anemia (6.1 %), and for patients with incomplete colonoscopy (3.0 %). The capsule returned findings in the esophagus in 52.1 % of patients, in the stomach in 45.5 % of patients, and in the small bowel in 70.7 % of patients, with the findings being considered relevant in 4.9 %, 9.7 %, and 22.6 % of patients, respectively. The whole extent of the digestive tract was fully recorded in 86.1 % of patients and the Z line could be fully observed in 57.6 % of patients. There were no adverse events. Conclusions: CCE allows the recording of images from almost the whole extent of the digestive tract in most patients, enabling relevant pathologies to be identified in extracolonic areas, particularly the small bowel. Technical and procedural improvements are still necessary in order to achieve better observation of the stomach and esophagus.

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.

PTU-058 Colon Capsule Endoscopy: A Useful Tool in the Diagnosis and Management of Inflammatory Bowel Disease: Abstract PTU-058 Table 1

Introduction Colon capsule endoscopy (CCE) is a novel non-invasive means of directly imaging the colonic mucosal surface. Limited data is available regarding the utility of CCE in the diagnosis and re-assessment of inflammatory bowel disease (IBD), but it is attractive to patients due to its non-invasive nature and ability to obtain small bowel and pan-colonic images. We present a large series of patients with known or suspected IBD undergoing CCE. Methods Retrospective, single-centre, including 193 patients with known or suspected IBD attending for CCE using PillCam Colon (Given Imaging, Israel). All patients known to have IBD successfully passed a PillCam Patency device prior. Demographical and procedural data was collated together with final diagnosis and management outcome. Results Mean age 38.8 years (range 17–82), 129 female, median follow-up 43 months (range 3–99). 71 chose CCE over colonoscopy, 66 refused colonoscopy, 49 had an incomplete colonoscopy, and 7 were unfit for colonoscopy. Indication for the procedure: known IBD (n = 66, 5 with ulcerative colitis, 61 with Crohn’s disease) of which 30 patients were undergoing CCE for disease re-assessment after 12 months of anti-TNF therapy and 36 due to a relapse in symptoms. The remaining 127 had suspected IBD. Procedure completion rate 75.5%, bowel preparation was good or adequate in 64.3%. There were no adverse events. In the known IBD group, 45 patients were diagnosed with active disease based on the CCE findings. This lead to changes in management in 44 patients (67%); mainly in the form of medication alteration (40 patients), but also by further investigation (4 patients). In the suspected IBD group, CCE diagnostic yield for IBD was 6%, 5 patients were diagnosed with Crohn’s disease and 2 patients were diagnosed with ulcerative colitis. In the group with small bowel inflammation 1 patient was diagnosed with NSAID related enteropathy and 1 had non-specific histology and is undergoing further investigation. Other clinically relevant alternative findings are outlined in Table 1 . Overall CCE made 37 clinically significant diagnoses in the small bowel rather than the colon; 27 in the known IBD group and 10 in the suspected IBD group. Abbreviations: IBD=inflammatory bowel disease Conclusion CCE is a useful patient friendly alternative for the diagnosis and re-assessment of patients with known or suspected IBD and impacts management. The distal small bowel is visualised with excellent clarity making CCE particularly useful for those with suspected or known ileocolonic disease. Disclosure of Interest None Declared

Pillcam Colon 2 in Crohn's Disease: Pan-enteric Tool for a Pan-enteric Disease

Pillcam Colon 2 in Crohn's Disease: Pan-enteric Tool for a Pan-enteric Disease

PillCam COLON 2 in Crohn's disease: A new concept of pan-enteric mucosal healing assessment.

To evaluate mucosal healing in patients with small bowel plus colonic Crohn's disease (CD) with a single non-invasive examination, by using PillCam COLON 2 (PCC2). Patients with non-stricturing nonpenetrating small bowel plus colonic CD in sustained corticosteroid-free remission were included. At diagnosis, patients had undergone ileocolonoscopy to identify active CD lesions, such as ulcers and erosions, and small bowel capsule endoscopy to assess the Lewis Score (LS). After ≥ 1 year of follow-up, patients underwent entire gastrointestinal tract evaluation with PCC2. The primary endpoint was assessment of CD mucosal healing, defined as no active colonic CD lesions and LS < 135. Twelve patients were included (7 male; mean age: 32 years), and mean follow-up was 38 mo. The majority of patients (83.3%) received immunosuppressive therapy. Three patients (25%) achieved mucosal healing in both the small bowel and the colon, while disease activity was limited to either the small bowel or the colon in 5 patients (42%). It was possible to observe the entire gastrointestinal tract in 10 of the 12 patients (83%) who underwent PCC2. Only three patients in sustained corticosteroid-free clinical remission achieved mucosal healing in both the small bowel and the colon, highlighting the limitations of clinical assessment when stratifying disease activity, and the need for pan-enteric endoscopy to guide therapeutic modification.

OC-050 Panenteric capsule endoscopy: whole gut visualisation without intubation

Introduction Capsule endoscopy (CE) is a well-tolerated, first line small bowel (SB) investigative modality. A specifically adapted version is available to image the colon, thus providing an option for non-invasive, single visit imaging of the entire gastrointestinal tract. This study evaluates a novel panenteric protocol utilised to investigate patients with symptoms which could originate from the SB, large bowel or both sites. Method Retrospective, single centre, involving consecutive patients attending for panenteric CE between July 2008 and December 2014. PillCam SB (Given Imaging, Israel) or MiroCam (Intromedic, Korea) and PillCam Colon 2 (Given Imaging) were used. All patients with known inflammatory bowel disease (IBD) successfully passed a PillCam Patency device prior. Patient demographics, procedural data, final diagnosis and outcomes were collected. Results 108 procedures were performed, mean age 41.5 years (range 16–95), 72 female, median follow up 27 months (range 2–79). 41 patients had known IBD (37 Crohn’s, 4 ulcerative colitis (UC)) and were undergoing disease re-assessment after 12 months of anti-TNF therapy (12), or due to relapse in symptoms (29). The remaining 67 patients had suspected IBD with predominant symptoms of diarrhoea (33), abdominal pain (15), iron deficiency anaemia (8), weight loss (6) and gastrointestinal bleeding (5). 51 patients refused colonoscopy, 37 chose CE over colonoscopy, 17 had an incomplete colonoscopy and 3 were unfit for colonoscopy. Panenteric capsule endoscopy completion rate (CECR) was 60.1% (65/108), SB CECR 86.1% (93/108) and colon CECR 71.3% (77/108). Colon CE bowel preparation was graded as good or excellent in 61.8%. 2 patients were excluded due to prolonged gastric retention of the colon capsule, 1 subsequently diagnosed with narcotic bowel syndrome. No complications were encountered. In the IBD group, 25 patients (61.0%) had evidence of active disease, leading to medication alterations in 21, surgery in 1 and conservative management in 3. Of the 16 patients in whom mucosal healing had been achieved, medication regimens were downgraded in 10 patients. In the suspected IBD group, this was identified in 13.4% (7 Crohns, 2 UC). Clinically relevant alternative findings included colon polyps (16), diverticular disease (9 colonic, 1 SB), angioectasia (6 SB, 1 colonic), and a small bowel carcinoid (1). The remaining 24 patients were diagnosed with functional bowel disorders and discharged. Of all the 34 patients with IBD identified, 22 had ileitis alone, 5 had ileocolonic disease and 7 had colonic disease alone. Conclusion Panenteric capsule endoscopy is feasible and can be performed safely in patients known to have IBD. It can be used to guide management without resorting to conventional endoscopy and identifies pathology in all areas of the GI tract. Disclosure of interest None Declared.