Clin Endosc.  2018 Jul;51(4):334-343. 10.5946/ce.2018.121.

Recent Advance in Colon Capsule Endoscopy: What's New?

• Hong SN
• Kang SH
• Jang HJ
• Wallace MB

• KMID: 2419704
• DOI: http://doi.org/10.5946/ce.2018.121

Abstract

Colon capsule endoscopy (CCE) is a relatively new diagnostic procedure for patients with suspected colonic diseases. This convenient, noninvasive method enables the physician to explore the entire colon without significant discomfort to the patient. However, while CCE can be performed painlessly without bowel air insufflation, the need for vigorous bowel preparation and other technical limitations exist. Due to such limitations, CCE has not replaced conventional colonoscopy. In this review, we discuss historical and recent advances in CCE including technical issues, ideal bowel preparation, indications and contraindications and highlight further technical advancements and clinical studies which are needed to develop CCE as a potential diagnostic tool.

Keyword

Colon; Capsule endoscopy; Colonoscopy

MeSH Terms

Capsule Endoscopy*
Colon*
Colonic Diseases
Colonoscopy
Humans
Insufflation
Methods

Figure

• 

  Fig. 1. Colon capsule endoscopy (Given Imaging Ltd., Yoqneam, Israel). (A) Upper panel represents the first generation colon capsule endoscopy (CCE-1) and the lower portion is the second generation colon capsule endoscopy (CCE-2). CCE-2 is slightly bigger than CCE-1. (B) Acetaminophen 650 mg (Tyrenol SR®) and CCE-2. (C) CCE-2 measures 11.6×31.5 mm, equal to 1 and 1/2 of the last joint of finger in an adult male.

• 

  Fig. 2. Examples of endoscopic pictures captured by colon capsule endoscopy (CCE). (A) Normal colonic mucosa. (B) Colorectal neoplasm: 17 mm-sized polyp was found at transverse colon during screening CCE (Courtesy of Professor Jae Jun Park from Yonsei University College of Medicine, Seoul, Korea).

Reference

1. Dominitz JA, Eisen GM, Baron TH, et al. Complications of colonoscopy. Gastrointest Endosc. 2003; 57:441–445.

2. Shafer LA, Walker JR, Waldman C, et al. Factors associated with anxiety about colonoscopy: the preparation, the procedure, and the anticipated findings. Dig Dis Sci. 2018; 63:610–618.

3. Iddan G, Meron G, Glukhovsky A, Swain P. Wireless capsule endoscopy. Nature. 2000; 405:417.

4. Liao Z, Gao R, Xu C, Li ZS. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc. 2010; 71:280–286.

5. Eliakim R, Fireman Z, Gralnek IM, et al. Evaluation of the PillCam colon capsule in the detection of colonic pathology: results of the first multicenter, prospective, comparative study. Endoscopy. 2006; 38:963–970.

6. Eliakim R, Yassin K, Niv Y, et al. Prospective multicenter performance evaluation of the second-generation colon capsule compared with colonoscopy. Endoscopy. 2009; 41:1026–1031.

7. Spada C, Hassan C, Galmiche JP, et al. Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2012; 44:527–536.

8. Kim YS, Hong CW, Kim BC, et al. Randomized clinical trial comparing reduced-volume oral picosulfate and a prepackaged low-residue diet with 4-liter PEG solution for bowel preparation. Dis Colon Rectum. 2014; 57:522–528.

9. Spada C, Riccioni ME, Hassan C, Petruzziello L, Cesaro P, Costamagna G. PillCam colon capsule endoscopy: a prospective, randomized trial comparing two regimens of preparation. J Clin Gastroenterol. 2011; 45:119–124.

10. Van Gossum A, Munoz-Navas M, Fernandez-Urien I, et al. Capsule endoscopy versus colonoscopy for the detection of polyps and cancer. N Engl J Med. 2009; 361:264–270.

11. Schoofs N, Devière J, Van Gossum A. PillCam colon capsule endoscopy compared with colonoscopy for colorectal tumor diagnosis: a prospective pilot study. Endoscopy. 2006; 38:971–977.

12. Spada C, Hassan C, Marmo R, et al. Meta-analysis shows colon capsule endoscopy is effective in detecting colorectal polyps. Clin Gastroenterol Hepatol. 2010; 8:516–522.

13. Garborg K, de Lange T, Bretthauer M. Quality indicators in colonoscopy. Curr Treat Options Gastroenterol. 2017; 15:416–428.

14. Gay G, Delvaux M, Frederic M, Fassler I. Could the colonic capsule PillCam colon be clinically useful for selecting patients who deserve a complete colonoscopy?: results of clinical comparison with colonoscopy in the perspective of colorectal cancer screening. Am J Gastroenterol. 2010; 105:1076–1086.

15. Wexner SD, Beck DE, Baron TH, et al. A consensus document on bowel preparation before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Gastrointest Endosc. 2006; 63:894–909.

16. Ramos L, Alarcón O, Adrian Z, et al. One-day versus two-day cleansing for colon capsule endoscopy: a prospective randomized pilot study. Gastroenterol Hepatol. 2014; 37:101–106.

17. Hartmann D, Keuchel M, Philipper M, et al. A pilot study evaluating a new low-volume colon cleansing procedure for capsule colonoscopy. Endoscopy. 2012; 44:482–486.

18. Spada C, Hassan C, Ingrosso M, et al. A new regimen of bowel preparation for PillCam colon capsule endoscopy: a pilot study. Dig Liver Dis. 2011; 43:300–304.

19. Shah HA, Paszat LF, Saskin R, Stukel TA, Rabeneck L. Factors associated with incomplete colonoscopy: a population-based study. Gastroenterology. 2007; 132:2297–2303.

20. Kakugawa Y, Saito Y, Saito S, et al. New reduced volume preparation regimen in colon capsule endoscopy. World J Gastroenterol. 2012; 18:2092–2098.

21. Riccioni ME, Urgesi R, Cianci R, Bizzotto A, Spada C, Costamagna G. Colon capsule endoscopy: advantages, limitations and expectations. Which novelties? World J Gastrointest Endosc. 2012; 4:99–107.

22. Ladas SD, Triantafyllou K, Spada C, et al. European Society of Gastrointestinal Endoscopy (ESGE): recommendations (2009) on clinical use of video capsule endoscopy to investigate small-bowel, esophageal and colonic diseases. Endoscopy. 2010; 42:220–227.

23. Han YM, Im JP. Colon capsule endoscopy: where are we and where are we going. Clin Endosc. 2016; 49:449–453.

24. Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2017; 112:1016–1030.

25. Berrington de Gonzalez A, Kim KP, Yee J. CT colonography: perforation rates and potential radiation risks. Gastrointest Endosc Clin N Am. 2010; 20:279–291.

26. Johnson CD, Herman BA, Chen MH, et al. The National CT Colonography Trial: assessment of accuracy in participants 65 years of age and older. Radiology. 2012; 263:401–408.

27. Stoop EM, de Haan MC, de Wijkerslooth TR, et al. Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomised controlled trial. Lancet Oncol. 2012; 13:55–64.

28. Sakamoto T, Mitsuzaki K, Utsunomiya D, et al. Detection of flat colorectal polyps at screening CT colonography in comparison with conventional polypoid lesions. Acta Radiol. 2012; 53:714–719.

29. IJspeert JE, Tutein Nolthenius CJ, Kuipers EJ, et al. CT-colonography vs. colonoscopy for detection of high-risk sessile serrated polyps. Am J Gastroenterol. 2016; 111:516–522.

30. Rondonotti E, Borghi C, Mandelli G, et al. Accuracy of capsule colonoscopy and computed tomographic colonography in individuals with positive results from the fecal occult blood test. Clin Gastroenterol Hepatol. 2014; 12:1303–1310.

31. Spada C, Hassan C, Barbaro B, et al. Colon capsule versus CT colonography in patients with incomplete colonoscopy: a prospective, comparative trial. Gut. 2015; 64:272–281.

32. Rex DK, Lieberman DA. A survey of potential adherence to capsule colonoscopy in patients who have accepted or declined conventional colonoscopy. J Clin Gastroenterol. 2012; 46:691–695.

33. Rokkas T, Papaxoinis K, Triantafyllou K, Ladas SD. A meta-analysis evaluating the accuracy of colon capsule endoscopy in detecting colon polyps. Gastrointest Endosc. 2010; 71:792–798.

34. Pilz JB, Portmann S, Peter S, Beglinger C, Degen L. Colon capsule endoscopy compared to conventional colonoscopy under routine screening conditions. BMC Gastroenterol. 2010; 10:66.

35. Sacher-Huvelin S, Coron E, Gaudric M, et al. Colon capsule endoscopy vs. colonoscopy in patients at average or increased risk of colorectal cancer. Aliment Pharmacol Ther. 2010; 32:1145–1153.

36. Brechmann T, Schmiegel W, Klute L, Rösch T, Pox C. Feasibility of a colon capsule overnight procedure followed by colonoscopy. Z Gastroenterol. 2016; 54:146–151.

37. Alvarez-Urturi C, Fernández-Esparrach G, Ibáñez IA, et al. Accuracy of colon capsule endoscopy in detecting colorectal polyps in individuals with familial colorectal cancer: could we avoid colonoscopies? Gastroenterol Res Pract. 2017; 2017:1507914.

38. Spada C, Hassan C, Munoz-Navas M, et al. Second-generation colon capsule endoscopy compared with colonoscopy. Gastrointest Endosc. 2011; 74:581–589. e1.

39. Hagel AF, Gäbele E, Raithel M, et al. Colon capsule endoscopy: detection of colonic polyps compared with conventional colonoscopy and visualization of extracolonic pathologies. Can J Gastroenterol Hepatol. 2014; 28:77–82.

40. Rex DK, Adler SN, Aisenberg J, et al. Accuracy of capsule colonoscopy in detecting colorectal polyps in a screening population. Gastroenterology. 2015; 148:948–957. e2.

41. Saito Y, Saito S, Oka S, et al. Evaluation of the clinical efficacy of colon capsule endoscopy in the detection of lesions of the colon: prospective, multicenter, open study. Gastrointest Endosc. 2015; 82:861–869.

42. Igawa A, Oka S, Tanaka S, Otani I, Kunihara S, Chayama K. Evaluation for the clinical efficacy of colon capsule endoscopy in the detection of laterally spreading tumors. Digestion. 2017; 95:43–48.

43. Ota Y, Yamada A, Kobayashi Y, et al. Diagnostic capability of colon capsule endoscopy for advanced colorectal cancer: a pilot study. Dig Endosc. 2017; 29:695–701.

44. Parodi A, Vanbiervliet G, Hassan C, et al. Colon capsule endoscopy to screen for colorectal neoplasia in those with family histories of colorectal cancer. Gastrointest Endosc. 2018; 87:695–704.

45. Given Imaging’s PillCam® COLON cleared in Japan, world’s second largest healthcare market [Internet]. Yoqneam: Given Imaging Ltd;c2013. [updated 2013 Jul 15; cited 2018 Jul 27]. Available from: https://globenewswire.com/news-release/2013/07/15/559866/10040275/en/Given-Imaging-s-PillCam-R-COLON-Cleared-in-Japan-World-s-Second-Largest-Healthcare-Market.html.

46. Sung J, Ho KY, Chiu HM, Ching J, Travis S, Peled R. The use of Pillcam colon in assessing mucosal inflammation in ulcerative colitis: a multicenter study. Endoscopy. 2012; 44:754–758.

47. Meister T, Heinzow HS, Domagk D, et al. Colon capsule endoscopy versus standard colonoscopy in assessing disease activity of ulcerative colitis: a prospective trial. Tech Coloproctol. 2013; 17:641–646.

48. Ye CA, Gao YJ, Ge ZZ, et al. PillCam colon capsule endoscopy versus conventional colonoscopy for the detection of severity and extent of ulcerative colitis. J Dig Dis. 2013; 14:117–124.

49. Shi HY, Chan FKL, Higashimori A, et al. A prospective study on second-generation colon capsule endoscopy to detect mucosal lesions and disease activity in ulcerative colitis (with video). Gastrointest Endosc. 2017; 86:1139–1146. e6.

50. Oliva S, Di Nardo G, Hassan C, et al. Second-generation colon capsule endoscopy vs. colonoscopy in pediatric ulcerative colitis: a pilot study. Endoscopy. 2014; 46:485–492.

51. D’Haens G, Löwenberg M, Samaan MA, et al. Safety and feasibility of using the second-generation Pillcam colon capsule to assess active colonic Crohn’s disease. Clin Gastroenterol Hepatol. 2015; 13:1480–1486. e3.

52. Oliva S, Cucchiara S, Civitelli F, et al. Colon capsule endoscopy compared with other modalities in the evaluation of pediatric Crohn’s disease of the small bowel and colon. Gastrointest Endosc. 2016; 83:975–983.

53. Niv Y, Gal E, Gabovitz V, Hershkovitz M, Lichtenstein L, Avni I. Capsule Endoscopy Crohn’s Disease Activity Index (CECDAIic or Niv Score) for the small bowel and colon. J Clin Gastroenterol. 2018; 52:45–49.

54. Leighton JA, Helper DJ, Gralnek IM, et al. Comparing diagnostic yield of a novel pan-enteric video capsule endoscope with ileocolonoscopy in patients with active Crohn’s disease: a feasibility study. Gastrointest Endosc. 2017; 85:196–205. e1.

55. Enns RA, Hookey L, Armstrong D, et al. Clinical practice guidelines for the use of video capsule endoscopy. Gastroenterology. 2017; 152:497–514.

56. Applicability of second-generation colon capsule endoscope to ulcerative colitis: a clinical feasibility study. J Gastroenterol Hepatol. 2013; 28:1174–1179.

57. ASGE Standards of Practice Committee, Saltzman JR, Cash BD, et al. Bowel preparation before colonoscopy. Gastrointest Endosc. 2015; 81:781–794.

58. Cheifetz AS, Kornbluth AA, Legnani P, et al. The risk of retention of the capsule endoscope in patients with known or suspected Crohn’s disease. Am J Gastroenterol. 2006; 101:2218–2222.

59. Argüelles-Arias F, San-Juan-Acosta M, Belda A, et al. Preparations for colon capsule endoscopy. Prospective and randomized comparative study between two preparations for colon capsule endoscopy: PEG 2 liters + ascorbic acid versus PEG 4 liters. Rev Esp Enferm Dig. 2014; 106:312–317.

60. Chatrath H, Rex DK. Potential screening benefit of a colorectal imaging capsule that does not require bowel preparation. J Clin Gastroenterol. 2014; 48:52–54.

61. Watabe H, Nakamura T, Yamada A, Kakugawa Y, Nouda S, Terano A. Assessment of an electronic learning system for colon capsule endoscopy: a pilot study. J Gastroenterol. 2016; 51:579–585.

62. Rosa B, Carvalho PB, Cotter J. Pillcam colon 2 in Crohn’s disease: pan-enteric tool for a pan-enteric disease. International Journal of Gastroenterology Disorders & Therapy. 2015; 2:116.

63. Remes-Troche JM, Jiménez-García VA, García-Montes JM, Hergueta-Delgado P, Roesch-Dietlen F, Herrerías-Gutiérrez JM. Application of colon capsule endoscopy (CCE) to evaluate the whole gastrointestinal tract: a comparative study of single-camera and dual-camera analysis. Clin Exp Gastroenterol. 2013; 6:185–192.

64. Triantafyllou K, Beintaris I, Dimitriadis GD. Is there a role for colon capsule endoscopy beyond colorectal cancer screening? A literature review. World J Gastroenterol. 2014; 20:13006–13014.

65. Friedel D, Modayil R, Stavropoulos S. Colon capsule endoscopy: review and perspectives. Gastroenterol Res Pract. 2016; 2016:9643162.

66. Singeap AM, Stanciu C, Trifan A. Capsule endoscopy: the road ahead. World J Gastroenterol. 2016; 22:369–378.

67. Sharma VK. The future is wireless: advances in wireless diagnostic and therapeutic technologies in gastroenterology. Gastroenterology. 2009; 137:434–439.

68. Keller J, Fibbe C, Volke F, et al. Inspection of the human stomach using remote-controlled capsule endoscopy: a feasibility study in healthy volunteers (with videos). Gastrointest Endosc. 2011; 73:22–28.

69. Swain P, Toor A, Volke F, et al. Remote magnetic manipulation of a wireless capsule endoscope in the esophagus and stomach of humans (with videos). Gastrointest Endosc. 2010; 71:1290–1293.

70. Ciuti G, Donlin R, Valdastri P, et al. Robotic versus manual control in magnetic steering of an endoscopic capsule. Endoscopy. 2010; 42:148–152.

71. Schostek S, Schurr MO. European research on wireless endoscopy--the VECTOR project. Stud Health Technol Inform. 2013; 189:193–199.

72. Rey JF, Ogata H, Hosoe N, et al. Blinded nonrandomized comparative study of gastric examination with a magnetically guided capsule endoscope and standard videoendoscope. Gastrointest Endosc. 2012; 75:373–381.