Capsule endoscopy in patients refusing conventional endoscopy

Abstract

Capsule endoscopy is nowadays the diagnostic technique of choice in the study of small bowel pathologies, allowing the non-invasive study of the entire mucosa. This has led, together with new technical advances, to the creation of two new models (PillCam ESO and PillCam Colon) for the study of esophageal and colonic diseases. These two new capsules offer an interesting alternative to conventional endoscopy in the study of the upper and lower digestive tracts, because traditional endoscopy is often unpleasant and uncomfortable for the patient, can be painful, often requires moderate or deep sedation and is not without complications (hemorrhage, perforation, etc.). PillCam Colon is particularly important for its usefulness in the diagnosis of colonic polyps, and is a potentially useful tool in cases of incomplete colonoscopy or in colorectal cancer screening, even more when most patients are reluctant to undergo screening programs due to the said disadvantages of conventional colonoscopy. This article discusses the advantages of capsule endoscopy over conventional endoscopy, its current application possibilities and indications in routine clinical practice. In the various sections of the work, we assess the application of endoscopic capsule in different sections of the digestive tract (esophagus, stomach, and colon) and finally the potential role of panendoscopy with PillCam Colon.

Keywords: Capsule endoscopy; Colon capsule endoscopy; Conventional endoscopy; Esophageal capsule endoscopy; Panendoscopy.

Figure 1

Suspected Barrett’s esophagus seen with PillCam ESO. A: Suspected long Barrett’s esophagus; B: Ectopic tissue mucosa ascending from Z line.

Figure 2

Esophageal varices seen with PillCam ESO. A: Large esophageal varices with red spots; B: Large esophageal varices in distal esophagus.

Figure 3

Diverticulosis coli.

Figure 4

Severe (A) and pseudopolyps in inactive (B) ulcerative colitis.

Figure 5

Colorectal cancer. A: Ulcerated sigmoid neoformation; B: Partially stenosing sigmoid neoformation.

Figure 6

Polyps. PillCam Colon-2 using polyp size estimation tool. PillCam Colon-2 using polyp size estimation tool. A: Senile ascending colon polyp; B: Millimetric descending colon polyps; C: Semi-pediculated polyp greater than 1cm in the sigmoid.

Figure 7

Suspected Barrett’s esophagus (A) and esophageal varices seen (B) with PillCam Colon.