Video capsule colonoscopy in routine clinical practice

Abstract

Background: Colon capsule endoscopy (CCE) offers direct mucosal visualisation without sedation or gas insufflation required in conventional colonoscopy (CC). However, evidence for the role of CCE as an adjunct or alternative to CC remains equivocal. In this observational cohort study, we report our experience of using CCE to investigate patients with suspected colon pathology at a tertiary referral centre.

Methods: From 2007-2015, consecutive patients requiring colonoscopy were recruited from a tertiary care centre in Malmo, Sweden. Data collected: patient demographics, indication for CCE, findings, bowel cleansing, colon transit time (CTT) and completeness of colon examination.

Results: Seventy-seven patients (57 F/20 F, median age 56 years) were included. The reason for CCE was previously incomplete or refused CC in 39 and 26 cases, and follow up of previous findings in 12 cases, respectively. The main clinical indications were gastrointestinal (GI) bleeding (n=28; 36%) and suspected inflammatory bowel disease (IBD) or follow-up of known IBD (n=23; 30%). CCE was complete in 58/77 (75%) patients. In 3 patients the colon was not reached; in the other 16, the capsule reached the rectum (n=4), sigmoid (n=6), descending colon (n=5) and transverse colon (n=1). Findings were: normal CCE (n=15; 19%) colonic diverticula (n=29; 38%), polyps (n=17; 22%), active IBD (n=12; 16%), haemorrhoids (n=8; 10%), colonic angioectasia (n=4; 5%) and cancer (n=1; 1%). Small-bowel findings were recorded in 8 (10%) patients. All patients tolerated bowel preparation and CCE well. Two patients with an ulcerated small-bowel stricture and cancer respectively experienced temporary capsule retention with spontaneous resolution.

Conclusions: CCE is a well-tolerated alternative to CC, but requires technological improvement and optimisation of clinical practice to meet current reference standards. Although further technical development is required, CCE may complement or even replace CC for certain clinical indications.

Keywords: Colon capsule endoscopy (CCE); capsule colonoscopy; colorectal cancer (CRC); gastrointestinal (GI) bleeding; inflammatory bowel disease (IBD).

Figure 1

Capsule endoscopic images of colon. (A) Angioectasia; (B) diverticula; (C) ulcerative colitis; (D) hemorrhoids; (E) 3-mm-large diminutive polyp (hyperplastic); (F) 10-mm-large pedunculated polyp (tubular adenoma); (G) 22-mm-large sessile polyp (tubular adenoma); (H) stricturing malignant tumour (adenocarcinoma).

Figure 2

Capsule endoscopic images of small bowel. (A) Normal; (B) angioectasia; (C) 15-mm-large submucosal tumor (lipoma); (D) tattoo; (E) Crohn’s erosions; (F) Crohn’s ulcers; (G) Crohn’s stenosis; (H) ischemic ulcerated stenosis.