Second-generation colon capsule endoscopy compared with colonoscopy

Abstract

Background. Colon capsule endoscopy (CCE) represents a noninvasive technology that allows visualization of the colon without requiring sedation and air insufflation. A second-generation colon capsule endoscopy system (PillCam Colon 2) (CCE-2) was developed to increase sensitivity for colorectal polyp detection compared with the firstgeneration system. Objective. To assess the feasibility, accuracy, and safety of CCE-2 in a head-to-head comparison with colonoscopy. Design and Setting. Prospective, multicenter trial including 8 European sites. Patients: This study involved 117 patients (mean age 60 years). Data from 109 patients were analyzed. Intervention. CCE-2 was prospectively compared with conventional colonoscopy as the criterion standard for the detection of colorectal polyps that are ≥6 mm or masses in a cohort of patients at average or increased risk of colorectal neoplasia. Colonoscopy was independently performed within 10 hours after capsule ingestion or on the next day. Main Outcome Measurements. CCE-2 sensitivity and specificity for detecting patients with polyps ≥6 mm and ≥10 mm were assessed. Capsule-positive but colonoscopynegative cases were counted as false positive. Capsule excretion rate, level of bowel preparation, and rate of adverse events also were assessed. Results. Per-patient CCE-2 sensitivity for polyps ≥6 mm and ≥10 mm was 84% and 88%, with specificities of 64% and 95%, respectively. All 3 invasive carcinomas were detected by CCE-2. The capsule excretion rate was 88% within 10 hours. Overall colon cleanliness for CCE-2 was adequate in 81% of patients. Limitations. Not unblinding the CCE-2 results at colonoscopy; heterogenous patient population; nonconsecutive patients. Conclusion. In this European, multicenter study, CCE-2 appeared to have a high sensitivity for the detection of clinically relevant polypoid lesions, and it might be considered an adequate tool for colorectal imaging.Abbreviations: CCE-2, second-generation colon capsule endoscopy; PEG, polyethylene glycol.

Colon capsule endoscopy: toward the future

“…To date, five studies have been published on polyp detection by CCE-2 compared with conventional colonoscopy [27][28][29][30][31]. These studies highlighted the considerably high sensitivity and specificity of CCE-2.…”

Where do I see minimally invasive endoscopy in 2020: clock is ticking

“…Later on, when the capsule enters the small intestine, either Sodium Phosphate (30 mL) boost, or a sachet of PicoLax followed by a liter of water is given, in order to move it to the colon and allow its exit through while photographing. Another smaller (15 mL) boost, or sachet of PicoLax might be needed depending on the capsule's location (5,6). Currently the percentage of capsules that are excreted while photographing from the anus exceeds 90%.…”

“…There have been two multicenter studies comparing, head to head, 2 nd generation CCE to optical colonoscopy, latter being the "gold standard" (5,6), and also one big study comparing both modalities in average risk surveillance population (15). A few studies comparing it to virtual colonoscopy in patients with incomplete colonoscopy were published with good results (16,17).…”

Alternatives to colonoscopy for population-wide colorectal cancer screening

“…54 Its sensitivity and specificity for significant polyps has been reported to be 83% and 89%, respectively. [55][56][57] The European Society of Gastrointestinal Endoscopy recommends CCE as an alternative screening method for average-risk individuals. 58 In February 2014, it also received the US Food and Drug Administration clearance for use in patients following incomplete colonoscopy.…”