Search metadata Search full text of books Search TV captions Search archived web sites Advanced Search. Endoscopy Unit, the Royal Infirmary of Edinburgh, Edinburgh, UK; 2. Gastroenterology Unit, Valduce Hospital, Como, Italy. Corresponding author. Contributions: (I) Conception and design: All authors; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: None; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Anastasios Koulaouzidis, MD, FEBG, FRSPH, FRCPE, FACG.
Endoscopy Unit, the Royal Infirmary of Edinburgh, 5. Little France Crescent, Edinburgh EH1. SA, UK. Email: moc. Received 2. 01. 6 Sep 2. Accepted 2. 01. 6 Oct 1. Copyright 2. 01. 6 Annals of Translational Medicine. All rights reserved. This article has been cited by other articles in PMC. Abstract. The colon capsule endoscopy (CCE) was first introduced in 2. Currently, the main clinical indications for CCE are completion of incomplete colonoscopy, polyp detection and investigation of inflammatory bowel disease (IBD). Although conventional colonoscopy is the gold standard in bowel cancer screening, incomplete colonoscopy remains a problem as lesions are missed. CCE compares favourably to computer tomography colonography (CTC) in adenoma detection and has therefore been proposed as a method for completing colonoscopy. However the data on CCE remains sparse and current evidence does not show its superiority over CTC or conventional colonoscopy in bowel cancer screening. CCE also seems to show good correlation with conventional colonoscopy when used to evaluate IBD, but there are not many published studies at present. Other significant limitations include the need for aggressive bowel preparation and the labour- intensiveness of CCE reading. Therefore, much further software and hardware development is required to enable CCE to fulfill its potential as a minimally- invasive and reliable method of colonoscopy. Keywords: Colon capsule endoscopy (CCE), colonoscopy, computer tomography colonography (CTC), colorectal cancer screening, adenomas, polyps, inflammatory bowel disease (IBD), review. Colon capsule specifications. The first- generation colon capsule endoscopy (CCE) was introduced in 2. The main difference between the CCE and conventional small bowel capsule endoscopes was the introduction of two optical domes at either end of the capsule to enable fuller visualisation of the relatively wider lumen structure in the colon. The currently available second- generation CCE (CCE- 2) (Medtronic, Minneapolis, USA) (Figure 1) consists of a swallowable video capsule (1. The battery life is about 1. It is equipped with the adaptive frame rate function, which modulates the frame rate according to capsule progression speed in order to save battery and optimise video length. The frame rate alternates between 4–3. The RAPID® reviewing system allows dual communication between the CE and data recorder. In addition, the new data recorder is able to actively elaborate information received from the capsule and to alert the patient at planned intervals to drive the laxative booster ingestion (2,3). At present the main clinical indications for CCE are: (I) completion of incomplete colonoscopy (Figure 2); (II) polyp detection (Figure 3); and (III) investigation of inflammatory bowel disease (IBD) (Figure 4). Anatomical landmarks (A) anal verge and (B) ileocaecal valve seen on CCE- 2. CCE- 2, second- generation CCE. Colonic polyps identified on CCE examinations. A) Melanosis coli and polyp; (B) pedunculated 1. C) sessile polyp; (D) polyp as in 2c viewed under FICE 1. CCE, colon capsule endoscopy. Proctitis as seen on CCE- 2. CCE- 2, second- generation CCE. The need for complete colonoscopy. Conventional colonoscopy is the gold standard in bowel cancer screening, but remains an uncomfortable experience for many patients, and clinical performance varies widely between endoscopists and centres (4- 6). As the incidence of bowel cancer increases, there is extra demand for high quality colonoscopy services. Therefore, a working group was formed in 2. Joint Advisory Group on Gastrointestinal Endoscopy (JAG), the British Society of Gastroenterology (BSG), and the Association of Coloproctology of Great Britain and Ireland (ACPGBI), to review existing and define new quality assurance measures and key performance indicators in colonoscopy (7). The major key quality indicators are caecal intubation rate and adenoma detection rate. Nowadays, caecal intubation rate is a well- recognized measure of colonoscopy quality and the working group has defined a target rate of 9. While large scale screening colonoscopy studies have reported a completion rate above this recommended threshold (8- 1. Incomplete colonoscopy is associated with missed lesions (1. Imperiale et al. (1. Consistently, a study by Brenner et al. Recently, Ridolfi et al. In 2. 1 patients (1. Stoffel et al. (1. CRC). They found that in patients diagnosed with CRC within a year after colonoscopy, 3. The same study reported that tumours found in patients who had had colonoscopies were more likely to be proximal; this could have been why these tumours had been missed initially. Clercq et al. (1. CRC. They found that 4. CRC were attributable to non- compliance with surveillance, 4. Factors associated with incomplete colonoscopy include poor bowel preparation, severe diverticulosis or stenosis, tortuous and redundant colon, low body mass index, previous abdominal surgery, female sex, young age, patient intolerance and ineffective sedation (1. Therefore, several technical and technological solutions have been suggested in recent years to achieve complete colonoscopy in these situations. These include the use of optimized bowel prep schedules or imaging techniques (i. Moreover, the endoscopist’s manual dexterity and expertise significantly affect the caecal intubation rate (2. Therefore, the large majority of patients with initial incomplete colonoscopy can undergo a successful repeated colonoscopy at tertiary referral centers (2. Nevertheless, in case of initial incomplete colonoscopy, several techniques alternative to conventional colonoscopy, such as computer tomography colonography (CTC) or CCE are also recommended. There appears to be a low to minimal risk of CCE retention (2,3,2. Use of CCE to complete colonoscopy. In 2. 00. 8 Spada et al. CCE managed complete colon inspection where conventional colonoscopy had been stopped at the sigmoid by inflammatory stenosis. In this patient the capsule showed a 1. Thereafter, other case- reports (2. CCE in patients with previous incomplete conventional colonoscopy. To the best of our knowledge, six cohort studies (3. CCE to complete colon examination (Table 1). These studies have collected more than 4. Significant findings were identified in more than one third of patients (range, 2. Based on these data, in 2. ESGE issued a guideline (3. CCE as a feasible and safe tool for visualization of the colonic mucosa in patients with incomplete colonoscopy without stenosis. In the same paper the authors recommended further randomized trials comparing CCE with radiological imaging and/or conventional colonoscopy in order to confirm the efficacy of CCE in this setting and define the patients in whom CCE is most suitable. Cohort studies evaluating the role of CCE in completing previous incomplete conventional colonoscopy. To the best of our knowledge, there has been only one prospective head- to- head study comparing CTC and CCE in patients with incomplete colonoscopy (3. In this study, 1. CCE and CTC; conventional colonoscopy was eventually performed if one of the two techniques identified significant findings (mass lesion or at least one polyp ≥6 mm). CCE was able to achieve complete colonic evaluation in the vast majority of patients (9. Compared to CTC, CCE identified more polyps with size thresholds of 6 and 1. CI): 1. 3. 4–2. 9. CI: 0. 6. 9–4. 0. No adverse events related to CCE or CTC were reported in this study. Interestingly, the study confirms the limitations of CTC in identifying flat/sessile lesions; all the 1. CTC and CCE were non- polypoid lesions (2 of them ≥1. Based on these findings, the authors concluded that both procedures are very effective in completing previous incomplete conventional colonoscopy, however, CCE seems to have a higher diagnostic yield. Nevertheless, since patients with negative CCE and CTC did not undergo repeat conventional colonoscopy, the false negative rate has not been assessed.
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