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Ohmiya N, Araki A, Tsuboi A, Nakamura K, Ito K, Hotta N, Kakugawa Y, Oka S, Saito Y, Kato T, Tanaka S. Multicenter prospective feasibility study on compliance, safety, and acceptance of small bowel and colon capsule endoscopy in the out-of-clinic setting in Japan. Dig Endosc 2025. [PMID: 39833116 DOI: 10.1111/den.14981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 12/01/2024] [Indexed: 01/22/2025]
Abstract
OBJECTIVES We aimed to determine the compliance, safety, and acceptance of colon capsule endoscopy (CCE) and small bowel capsule endoscopy (SBCE) in an out-of-clinic setting remotely supported by medical staff. METHODS We enrolled 30 examinees (24 with CCE and six with SBCE) who had not undergone CE at six gastroenterological centers. All examinees were provided with instructions on equipment and bowel preparations. RESULTS CCE was performed at home (n = 16) or at the workplace (n = 8). Compliance with data-recorder alerts was 100% for bowel preparation and 79% for equipment operation. Total capsule colonoscopy was achieved in 83.3%. The overall adequate endoscopic cleansing rate was 83.3%, and abnormalities, including colorectal polyps, were detected in 37.5%. CCE malfunction, such as the inability to automatically detect the small bowel mucosa occurred in one (4.2%). One experienced mild abdominal pain that required no treatment. Inquiries were present from half of the examinees. The proportions of examinees who desired and refused CCE at the next examination were 67% and 4%, respectively. SBCE was performed at home (n = 4) or at the workplace (n = 2). Compliance with the procedures was 100%. Whole small bowel images were recorded for all examinees. The overall adequate endoscopic clearness rate was 100%. One abnormality was detected. Inquiries were present from half of the examinees. There were no adverse events or malfunctions. The proportion of examinees who reported "quite easy" and "fairly easy" was 66%. CONCLUSION CCE and SBCE with all procedures in the out-of-clinic setting supported by remote consultations were feasible. A multicenter prospective study of the safety and acceptance of capsule endoscopy examinations at home (HomeCam-J study) (jRCTs042220163).
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Affiliation(s)
- Naoki Ohmiya
- Departments of Gastroenterology and Advanced Endoscopy, Fujita Health University School of Medicine, Aichi, Japan
| | - Akihiro Araki
- Health Management Center, Toranomon Hospital, Tokyo, Japan
| | - Akiyoshi Tsuboi
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Keiko Nakamura
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Kyoko Ito
- Centre for Preventive Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Naoki Hotta
- Department of Advanced Endoscopy, Fujita Health University School of Medicine, Aichi, Japan
- Department of Internal Medicine, Masuko Memorial Hospital, Aichi, Japan
| | - Yasuo Kakugawa
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Tomohiro Kato
- Centre for Preventive Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinji Tanaka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
- Department of Gastroenterology, JA Onomichi General Hospital, Hiroshima, Japan
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Nielsen AB, Jensen MD, Brodersen JB, Kjeldsen J, Laursen CB, Konge L, Laursen SB. More than 20 procedures are necessary to learn small bowel capsule endoscopy: Learning curve pilot study of 535 trainee cases. Endosc Int Open 2024; 12:E697-E703. [PMID: 38812698 PMCID: PMC11136552 DOI: 10.1055/a-2308-1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/13/2024] [Indexed: 05/31/2024] Open
Abstract
Background and study aims The number of procedures needed to acquire a sufficient level of skills to perform an unassisted evaluation of small bowel capsule endoscopy (SBCE) is unknown. We aimed to establish learning curves, diagnostic accuracy, and the number of procedures needed for reviewing small bowel capsule endoscopies unassisted. Methods An expert panel developed a 1-day course including lessons (examination, anatomy, and pathology) and hands-on training. After completing the course, participants received 50 cases in a randomized sequence. An interactive questionnaire about landmarks, findings, and diagnosis followed each case. After submitting the questionnaire, participants received feedback. Data are presented using CUSUM (cumulative sum control chart) learning curves and sensitivity/specificity analyses compared with expert opinions. Results We included 22 gastroenterologists from 11 different Danish hospitals. A total of 535 cases were reviewed (mean: 28; range: 11-50). CUSUM plots demonstrated learning progression for diagnosis and findings during the course, but none of the participants reached a learning plateau with sufficient competencies. The sensitivity for all findings was 65% (95% confidence interval [CI] 0.51-0.82) for the first 20 procedures and 67% (95% CI 0.58-0.73) from case 21 until completion or dropout. The specificity was 63% (95% CI 0.52-0.74) for the first 20 procedures and 57% (95% CI 0.37-0.77) for the rest. Conclusions Our data indicate that learning SBCE may be more difficult than previously recognized due to low discriminative abilities after 20 cases except for the identification of CD. This indicates that 20 SBCE cases may not be sufficient to achieve competency for reviewing SBCE without supervision.
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Affiliation(s)
- Anders Bo Nielsen
- Research Unit of Medical Education, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
- Research Unit of OPEN - Open Patient data Explorative Network, University of Southern Denmark Department of Clinical Research, Odense, Denmark
- Department of Anesthesiology and Intensive Care, Svendborg, Odense University Hospital, Odense, Denmark
| | - Michael Dam Jensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Internal Medicine, Section of Gastroenterology, Hospital South West Jutland, Esbjerg, Denmark
| | - Jacob Broder Brodersen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Internal Medicine, Section of Gastroenterology, Hospital South West Jutland, Esbjerg, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark Department of Clinical Research, Odense, Denmark
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), University of Southern Denmark Department of Clinical Research, Odense, Denmark
| | - Lars Konge
- Research Unit of Medical Education, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark, Copenhagen, Denmark
| | - Stig Borbjerg Laursen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark Department of Clinical Research, Odense, Denmark
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Mizukami K, Inumaru Y, Akiyama H, Fukuda K, Okamoto K, Fujioka T, Okimoto T, Murakami K. Efficacy of the Castor Oil-Filled Capsule Method as Preparation for Colon Capsule Endoscopy. Digestion 2023; 104:409-414. [PMID: 37071981 DOI: 10.1159/000529648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 02/06/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Colon capsule endoscopy (CCE) is useful as an alternative examination for patients in whom colonoscopy is difficult. The Japanese Association for Capsule Endoscopy has published a recommended regimen for CCE using castor oil, which is becoming a standard examination method for CCE in Japan. However, castor oil has an unpleasant flavor. Therefore, patient acceptance is not good. OBJECTIVES The aims were to develop a castor oil-filled capsule and evaluate its feasibility and patient acceptance in a retrospective, comparative study. METHOD A dissolution study of pig-derived gelatin capsules filled with castor oil was performed using artificial gastric juice. The CCE excretion rates within battery lifetime, CCE examination times, endoscopic colonic cleansing levels, and patient acceptability between CCE boosters with a castor oil-filled capsule and without castor oil were retrospectively compared using medical information, clinical data, and endoscopic findings at Takada Chuo Hospital from September 2016 to August 2019. RESULTS The castor oil-filled capsules were completely disintegrated at approximately 1-3 min in artificial gastric juice. Bowel preparation with oil-filled capsules and without castor oil was performed in 27 and 24 patients, respectively. CCE excretion rates within battery life were 100% and 91.7% (p = 0.217), small bowel transit times were 115 min and 143 min (p = 0.046), colon transit times were 168 min and 148 min (p = 0.733), and adequate colonic cleansing rates were 85.2% and 86.3% (p = 1.000) in patients using bowel preparation with and without oil-filled capsules, respectively. Regarding acceptance, the taste was not problematic in 85.2%, and tolerability for the next CCE was 96.3%. CONCLUSIONS CCE using a castor oil-filled capsule method achieved high examination performance and sufficient patient tolerability.
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Affiliation(s)
- Kazuhiro Mizukami
- Department of Gastroenterology, Oita University, Oita, Japan
- Gastroenterological Disease Endoscopy Center, Takada Chuo Hospital, Oita, Japan
| | - Yoshito Inumaru
- Gastroenterological Disease Endoscopy Center, Takada Chuo Hospital, Oita, Japan
| | | | - Kensuke Fukuda
- Department of Gastroenterology, Oita University, Oita, Japan
- Gastroenterological Disease Endoscopy Center, Takada Chuo Hospital, Oita, Japan
| | - Kazuhisa Okamoto
- Department of Gastroenterology, Oita University, Oita, Japan
- Gastroenterological Disease Endoscopy Center, Takada Chuo Hospital, Oita, Japan
| | - Toshio Fujioka
- Department of Internal Medicine, Takada Chuo Hospital, Oita, Japan
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Nakamura T. Capsule endoscopy in Japan. Dig Endosc 2022; 34 Suppl 2:76-78. [PMID: 35132684 DOI: 10.1111/den.14236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Tetsuya Nakamura
- Department of Medical Informatics, School of Medicine, Dokkyo Medical University, Tochigi, Japan
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Lee B, Lin K, Liang PS. Effectiveness and Harms of Colorectal Cancer Screening Strategies. Gastrointest Endosc Clin N Am 2022; 32:215-226. [PMID: 35361332 DOI: 10.1016/j.giec.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Colorectal cancer screening incorporates various testing modalities. Factors including effectiveness, harms, cost, screening interval, patient preferences, and test availability should be considered when determining which test to use. Fecal occult blood testing and endoscopic screening have the most robust evidence, while newer blood- and imaging-based techniques require further evaluation. In this review, we compare the effectiveness, harms, and costs of the various screening strategies.
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Affiliation(s)
- Briton Lee
- Department of Medicine, NYU Langone Health, 550 First Avenue, NBV 16 North 30, New York, NY 10016, USA
| | - Kevin Lin
- Department of Medicine, NYU Langone Health, 550 First Avenue, NBV 16 North 30, New York, NY 10016, USA
| | - Peter S Liang
- Department of Medicine, NYU Langone Health, 550 First Avenue, NBV 16 North 30, New York, NY 10016, USA; Department of Medicine, VA New York Harbor Health Care System, 423 E 23rd Street, 11N, GI, New York, NY 10010, USA.
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Brodersen JB, Andersen KW, Jensen MD. Adherence to the bowel cleansing regimen for pan-enteric capsule endoscopy in patients with suspected Crohn's disease and factors affecting the image quality. Scand J Gastroenterol 2022; 57:501-506. [PMID: 34915794 DOI: 10.1080/00365521.2021.2016945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Pan-enteric capsule endoscopy (CE) is an attractive diagnostic approach in patients examined for Crohn's disease (CD). The aim of this study was to examine the adherence to the recommended bowel cleansing regimen and determine clinical factors affecting the image quality. METHODS In a prospective blinded trial, patients with suspected CD were examined with the PillCam Crohn's capsule after bowel preparation with 2 + 2 L of polyethylene glycol (PEG) and sodium phosphate booster. The image quality was graded on a four-point scale. A good or excellent image quality defined a diagnostic procedure. RESULTS Fifty-nine patients participated. The mean volume of PEG was 2.5 L (CI 2.3-2.8). Ten patients (17%) were able to drink all 4 L of PEG, and 44 patients (75%) ingested ≥2 L. The image quality was poor, fair, good or excellent in 0%, 29.3%, 29.3% and 41.4%, respectively. The mean volume of PEG was 1.9 L (CI 1.4-2.4), 2.2 L (CI 1.8-2.7) and 3.2 L (CI 2.8-3.5) in patients with a fair, good or excellent image quality (p < .001). In a regression analysis, only the volume of PEG was associated with the obtained image quality (rs=0.52; p < .001). The diagnostic yield was equal in patients with a diagnostic or non-diagnostic procedure (43.9% and 47.1%, respectively). CONCLUSIONS In patients examined with pan-enteric CE for suspected CD, the volume of PEG is the major factor affecting the image quality. Although few patients are able to ingest the recommended volume, the diagnostic yield is not affected.
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Affiliation(s)
- Jacob Broder Brodersen
- Department of Internal Medicine, Section of Gastroenterology, Hospital of South West Jutland, Esbjerg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Karina Winther Andersen
- Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital, Vejle, Denmark
| | - Michael Dam Jensen
- Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital, Vejle, Denmark
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Bjoersum-Meyer T, Skonieczna-Zydecka K, Cortegoso Valdivia P, Stenfors I, Lyutakov I, Rondonotti E, Pennazio M, Marlicz W, Baatrup G, Koulaouzidis A, Toth E. Efficacy of bowel preparation regimens for colon capsule endoscopy: a systematic review and meta-analysis. Endosc Int Open 2021; 9:E1658-E1673. [PMID: 34790528 PMCID: PMC8589531 DOI: 10.1055/a-1529-5814] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/04/2021] [Indexed: 12/11/2022] Open
Abstract
Background and study aims Colon capsule endoscopy (CCE) is an alternative to conventional colonoscopy (CC) in specific clinical settings. High completion rates (CRs) and adequate cleanliness rates (ACRs) are fundamental quality parameters if CCE is to be widely implemented as a CC equivalent diagnostic modality. We conducted a systematic review and meta-analysis to investigate the efficacy of different bowel preparations regimens on CR and ACR in CCE. Patients and methods We performed a systematic literature search in PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library. Data were independently extracted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The primary outcome measures (CR, ACR) were retrieved from the individual studies and pooled event rates were calculated. Results Thirty-four observational (OBS) studies (n = 3,789) and 12 randomized clinical trials (RCTs) (n = 1,214) comprising a total 5,003 patients were included. The overall CR was 0.798 (95 % CI, 0.764-0.828); the highest CRs were observed with sodium phosphate (NaP) + gastrografin booster (n = 2, CR = 0.931, 95 % CI, 0.820-0.976). The overall ACR was 0.768 (95 % CI, 0.735-0.797); the highest ACRs were observed with polyethylene glycol (PEG) + magnesium citrate (n = 4, ER = 0.953, 95 % CI, 0.896-0.979). Conclusions In the largest meta-analysis on CCE bowel preparation regimens, we found that both CRs and ACRs are suboptimal compared to the minimum recommended standards for CC. PEG laxative and NaP booster were the most commonly used but were not associated with higher CRs or ACRs. Well-designed studies on CCE should be performed to find the optimal preparation regimen.
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Affiliation(s)
| | | | - Pablo Cortegoso Valdivia
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy.
| | - Irene Stenfors
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Ivan Lyutakov
- Department of Gastroenterology, University Hospital “Tsaritsa Yoanna – ISUL”, Medical University Sofia, Bulgaria
| | | | - Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, Turin, Italy
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland,The Centre for Digestive Diseases, Endoklinika, Szczecin, Poland
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Odense Denmark
| | - Anastasios Koulaouzidis
- Department of Social Medicine & Public Health, Pomeranian Medical University, Szczecin, Poland
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
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Semenov S, Ismail MS, O'Hara F, Sihag S, Ryan B, O'Connor A, O'Donnell S, McNamara D. Addition of castor oil as a booster in colon capsule regimens significantly improves completion rates and polyp detection. World J Gastrointest Pharmacol Ther 2021; 12:103-112. [PMID: 34877028 PMCID: PMC8611183 DOI: 10.4292/wjgpt.v12.i6.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/02/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Incomplete excretion rates are problematic for colon capsule endoscopy (CCE). Widely available booster regimens are suboptimal. Recently published data on one day preparation CCE protocol using castor oil appeared effective.
AIM To assess the impact of adding castor oil to a standard split-dose (2-d) preparation in an unselected Western patient cohort.
METHODS All patients aged 18 or more referred to our unit for a CCE over a 5-mo period were prospectively recruited. Controls were retrospectively identified from our CCE database. All patients received split bowel preparation with Moviprep® [polyethylene glycol (PEG)-3350, sodium sulphate, sodium chloride, potassium chloride, sodium ascorbate and ascorbic acid for oral solution; Norgine B. V, United States], a PEG-based solution used predominantly in our colonoscopy practice. Control booster regimen included Moviprep® with 750 mL of water (booster 1) on reaching the small bowel. A further dose of Moviprep® with 250 mL of water was given 3 h later and a bisacodyl suppository (Dulcolax®) 10 mg after 8 h, if the capsule was not excreted. In addition to our standard booster regimen, cases received an additional 15 mL of castor oil given at the time of booster 1. A nested case control design with 2:1 ratio (control:case) was employed. Basic demographics, completion rates, image quality, colonic transit time, diagnostic yield and polyp detection were compared between groups, using a student t or chi-square tests as appropriate.
RESULTS One hundred and eighty-six CCEs [mean age 60 years (18-97), 56% females, n = 104], including 62 cases have been analysed. Indication breakdown included 96 polyp surveillance (51.6%), 42 lower gastrointestinal symptoms (22.6%), 28 due to incomplete colonoscopy (15%), 18 anaemia (9.7%) and 2 inflammatory bowel disease surveillance (1.1%). Overall, CCE completion was 77% (144/186), image quality was adequate/diagnostic in 91% (170/186), mean colonic transit time was 3.5 h (0.25-13), and the polyp detection rate was 57% (106/186). Completion rates were significantly higher with castor oil, 87% cases (54/62) vs 73% controls (90/124), P = 0.01. The number needed to treat with castor oil to result in an additional complete CCE study was 7, absolute risk reduction = 14.52%, 95% confidence interval (CI): 3.06- 25.97. This effect of castor oil on excretion rates was more significant in the over 60 s, P < 0.03, and in females, P < 0.025. Similarly, polyp detection rates were higher in cases 82% (51/62) vs controls 44% (55/124), P = 0.0001, odds ratio 5.8, 95%CI: 2.77-12.21. Colonic transit times were similar, 3.2 h and 3.8 h, respectively. Image quality was similar, reported as adequate/ diagnostic in 90% (56/62) vs 92% (114/124).
CONCLUSION In our capsule endoscopy centre, castor oil addition as a CCE booster significantly improved completion rates and polyp detection in an unselected Western cohort.
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Affiliation(s)
- Serhiy Semenov
- Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland
- Trinity Academic Gastroenterology Group, Trinity College Dublin, Dublin D 2, Ireland
| | - Mohd Syafiq Ismail
- Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland
- Trinity Academic Gastroenterology Group, Trinity College Dublin, Dublin D 2, Ireland
| | - Fintan O'Hara
- Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland
- Trinity Academic Gastroenterology Group, Trinity College Dublin, Dublin D 2, Ireland
| | - Sandeep Sihag
- Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland
- Trinity Academic Gastroenterology Group, Trinity College Dublin, Dublin D 2, Ireland
| | - Barbara Ryan
- Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland
| | - Anthony O'Connor
- Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland
| | - Sarah O'Donnell
- Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland
| | - Deirdre McNamara
- Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland
- Trinity Academic Gastroenterology Group, Trinity College Dublin, Dublin D 2, Ireland
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Lavage, Simethicone, and Prokinetics-What to Swallow with a Video Capsule. Diagnostics (Basel) 2021; 11:diagnostics11091711. [PMID: 34574051 PMCID: PMC8465944 DOI: 10.3390/diagnostics11091711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022] Open
Abstract
The development of new capsules now allows endoscopic diagnosis in all segments of the gastrointestinal tract and comes with new needs for differentiated preparation regimens. Although the literature is steadily increasing, the results of the conducted trials on preparation are sometimes conflicting. The ingestion of simethicone before gastric and small bowel capsule endoscopy for prevention of air bubbles is established. The value of a lavage before small bowel capsule endoscopy (SBCE) is recommended, although not supported by all studies. Ingestion in the morning before the procedure seems useful for the improvement of mucosa visualization. Lavage after swallowing of the capsule seems to improve image quality, and in some studies also diagnostic yield. Prokinetics has been used with first generation capsules to shorten gastric transit time and increase the rate of complete small bowel visualization. With the massively prolonged battery capacity of the new generation small bowel capsules, prokinetics are only necessary in significantly delayed gastric emptying as documented by a real-time viewer. Lavage is crucial for an effective colon capsule or pan-intestinal capsule endoscopy. Mainly high or low volume polyethylene glycol (PEG) is used. Apart from achieving optimal cleanliness, propulsion of the capsule by ingested boosts is required to obtain a complete passage through the colon within the battery lifetime. Boosts with low volume sodium picosulfate (NaP) or diatrizoate (gastrografin) seem most effective, but potentially have more side effects than PEG. Future research is needed for more patient friendly but effective preparations, especially for colon capsule and pan-intestinal capsule endoscopy.
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Takashima K, Komeda Y, Sakurai T, Masaki S, Nagai T, Matsui S, Hagiwara S, Takenaka M, Nishida N, Kashida H, Nakaji K, Watanabe T, Kudo M. Castor oil as booster for colon capsule endoscopy preparation reduction: A prospective pilot study and patient questionnaire. World J Gastrointest Pharmacol Ther 2021. [DOI: 10.4292/wjg.v12.i4.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Takashima K, Komeda Y, Sakurai T, Masaki S, Nagai T, Matsui S, Hagiwara S, Takenaka M, Nishida N, Kashida H, Nakaji K, Watanabe T, Kudo M. Castor oil as booster for colon capsule endoscopy preparation reduction: A prospective pilot study and patient questionnaire. World J Gastrointest Pharmacol Ther 2021; 12:79-89. [PMID: 34316385 PMCID: PMC8290927 DOI: 10.4292/wjgpt.v12.i4.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/22/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Preparation for colon capsule endoscopy (CCE) requires a large liquid laxative volume for capsule excretion, which compromises the procedure's tolerability. AIM To assess the safety and utility of castor oil-boosted bowel preparation. METHODS This prospective cohort study including 20 patients (age range, 16-80 years; six men and 14 women) suspected of having colorectal disease was conducted at Kindai University Hospital from September 2017 to August 2019. All patients underwent CCE because of the following inclusion criteria: previous incomplete colonoscopy in other facility (n = 20), history of abdominal surgery (n = 7), or organ abnormalities such as multiple diverticulum (n = 4) and adhesion after surgery (n = 6). The exclusion criteria were as follows: Dysphagia, history of allergic reactions to the drugs used in this study (magnesium citrate, polyethylene glycol, metoclopramide, and castor oil), possibility of pregnancy, possibility of bowel obstruction or stenosis based on symptoms, or scheduled magnetic resonance imaging within 2 wk after CCE. The primary outcome was the capsule excretion rate within the battery life, as evaluated by the total large bowel observation rate, large bowel transit time, and bowel creasing level using a five-grade scale in different colorectal segments. The secondary outcomes were complications, colorectal lesion detection rates, and patients' tolerability. RESULTS The castor oil-based regimen was implemented in 17 patients. Three patients cancelled CCE because they could tolerate castor oil, but not liquid laxatives. The capsule excretion rate within the battery life was 88% (15/17). The mean large bowel transit time was 236 min. Approximately 70% of patients had satisfactory colon cleansing levels. CCE detected colon polyps (14/17, 82%) and colonic diverticulum (4/12, 33%). The sensitivity, specificity, and diagnostic accuracy rates for detecting colorectal polyps (size ≥ 6 mm) were 76.9%, 75.0%, and 76.4%, respectively. The sensitivity, specificity, and diagnostic accuracy rates for detection of diverticulum were 100% each. Twelve patients (71%) rated CCE as more than "good", confirming the new regimen's tolerability. No serious adverse events occurred during this study. CONCLUSION The castor oil-based regimen could reduce bowel preparation dose and improve CCE tolerability.
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Affiliation(s)
- Kota Takashima
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Toshiharu Sakurai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Sho Masaki
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Tomoyuki Nagai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Shigenaga Matsui
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Satoru Hagiwara
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Hiroshi Kashida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Konosuke Nakaji
- Division of Gastroenterology, Department of Internal Medicine, Endoscopy Center, Aishinkai Nakae Hospital, Wakayama-Shi 640-8461, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
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12
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Neumann H, Latorre M, Zimmerman T, Lang G, Samarasena J, Gross S, Brahmbhatt B, Pazwash H, Kushnir V. A multicenter, prospective, inpatient feasibility study to evaluate the use of an intra-colonoscopy cleansing device to optimize colon preparation in hospitalized patients: the REDUCE study. BMC Gastroenterol 2021; 21:232. [PMID: 34022813 PMCID: PMC8140575 DOI: 10.1186/s12876-021-01817-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/13/2021] [Indexed: 01/19/2023] Open
Abstract
Background High quality bowel preparation prior to colonoscopy can be difficult to achieve in the inpatient setting. Hospitalized patients are at risk for extended hospital stays and low diagnostic yield due to inadequate bowel preparation.
The Pure-Vu System is a novel device intended to fit over existing colonoscopes to improve intra-colonoscopy bowel preparation. The objective of the REDUCE study was to conduct the first inpatient study to evaluate optimization of bowel preparation quality following overnight preparation when using the Pure-Vu System during colonoscopy. Methods This multicenter, prospective feasibility study enrolled hospitalized subjects undergoing colonoscopy. Subjects recorded the clarity of their last bowel movement using a 5-point scale prior to colonoscopy. After one night of preparation, all enrolled subjects underwent colonoscopy utilizing the Pure-Vu System. The primary endpoint was improvement of colon cleanliness from baseline to post-cleansing with the Pure-Vu System as assessed by the improvement in Boston Bowel Preparation Scale (BBPS). An exploratory analysis was conducted to assess whether the clarity of the last bowel movement could predict inadequate bowel preparation. Results Ninety-four subjects were included. BBPS analyses showed significant improvements in bowel preparation quality across all evaluable colon segments after cleansing with Pure-Vu, including left colon (1.74 vs 2.89; p < 0.0001), transverse colon (1.74 vs 2.91; p < 0.0001), and the right colon (1.41 vs 2.88; p < 0.0001). Prior to Pure-Vu, adequate cleansing (BBPS scores of ≥ 2) were reported in 60%, 62%, and 47% for the left colon, transverse colon, and right colon segments, respectively. After intra-colonoscopy cleansing with the Pure-Vu System, adequate colon preparation was reported in 100%, 99%, and 97% of the left colon, transverse colon, and right colon segments, respectively. Subjects with lower bowel movement clarity scores were more likely to have inadequate bowel preparation prior to cleansing with Pure-Vu. Conclusions In this feasibility study, the Pure-Vu System appears to be effective in significantly improving bowel preparation quality in hospitalized subjects undergoing colonoscopy. Clarity of last bowel movement may be useful indicator in predicting poor bowel preparation. Larger studies powered to evaluate clinical outcomes, hospital costs, and blinded BBPS assessments are required to evaluate the significance of these findings. Trial registration Evaluation of the Bowel Cleansing in Hospitalized Patients Using Pure-Vu System (NCT03503162).
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Affiliation(s)
- Helmut Neumann
- Department of Gastroenterology and Hepatology, University Medical Center Mainz, Mainz, Germany
| | - Melissa Latorre
- Division of Gastroenterology and Hepatology, New York University Langone Medical Center, New York City, NY, USA
| | - Tim Zimmerman
- Department of Gastroenterology and Hepatology, University Medical Center Mainz, Mainz, Germany
| | - Gabriel Lang
- Division of Gastroenterology, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8124, St. Louis, MO, 63110, USA
| | - Jason Samarasena
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, Irvine, Orange, CA, USA
| | - Seth Gross
- Division of Gastroenterology and Hepatology, New York University Langone Medical Center, New York City, NY, USA
| | - Bhaumik Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Haleh Pazwash
- Division of Gastroenterology, Valley Hospital, Ridgewood, NJ, USA
| | - Vladimir Kushnir
- Division of Gastroenterology, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8124, St. Louis, MO, 63110, USA.
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13
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Hosoe N, Limpias Kamiya KJL, Hayashi Y, Sujino T, Ogata H, Kanai T. Current status of colon capsule endoscopy. Dig Endosc 2021; 33:529-537. [PMID: 32542702 DOI: 10.1111/den.13769] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/16/2022]
Abstract
While both the annual incidence and mortality of colorectal cancer are slowly but steadily decreasing in the United States, the incidence of such malignancy is increasing in Japan. Thus, controlling colorectal cancer in Japan is a major concern. In 2006, colon capsule endoscopy was first introduced by Eliakim et al. First-generation colon capsule endoscopy had a moderate sensitivity for detecting polyps of more than 6 mm. Thus, second-generation colon capsule endoscopy was developed to achieve higher sensitivity. Colonoscopy is the gold standard tool for colorectal cancer surveillance. With an improvement in the imaging function, the performance of second-generation colon capsule endoscopy is almost as satisfactory as that of colonoscopy. Certain situations, such as incomplete colonoscopy and contraindication for use of sedation, can benefit from colon capsule endoscopy. Colon capsule endoscopy requires a more extensive bowel preparation than colonoscopy and computed tomography colonography because it requires laxatives not only for bowel cleansing but also for promoting the excretion of the capsule. Another problem with colon capsule endoscopy includes the burden of reading and interpretation and overlook of the lesions. Currently, the development of automatic diagnosis of colon capsule endoscopy using artificial intelligence is still under progress. Although the available guidelines do not support the use of colon capsule endoscopy for inflammatory bowel disease, the possible application of colon capsule endoscopy is ulcerative colitis. This review article summarizes and focuses on the current status of colon capsule endoscopy for colorectal cancer screening and the possibility for its applicability on inflammatory bowel disease.
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Affiliation(s)
- Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Kenji J L Limpias Kamiya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yukie Hayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomohisa Sujino
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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14
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Koffas A, Laskaratos FM, Epstein O. Training in video capsule endoscopy: Current status and unmet needs. World J Gastrointest Endosc 2019; 11:395-402. [PMID: 31236192 PMCID: PMC6580306 DOI: 10.4253/wjge.v11.i6.395] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/19/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023] Open
Abstract
Since its introduction to clinical practice nearly 20 years ago, wireless capsule endoscopy has revolutionized the landscape in the diagnosis and management of small bowel diseases. Over the past 10 years, capsule endoscopy has evolved beyond the small intestine and a range of capsules are now available to examine the esophagus, stomach and colon. Because of its ease of use, tolerability, paucity of complications and ability to visualize the entire gastrointestinal tract, capsule endoscopy has entered the mainstream of clinical practice. This review of the literature summarizes the current state of capsule training and highlights the limited data available to assess reader competence and standards expected of an independent practitioner. There are neither standardized teaching strategies nor national or international metrics for accreditation of physicians and non-physicians interested in mastering this examination. Summating the few publications, there appears to be consensus that diagnostic expertise improves with experience, and that trainees should be fully supervised for at least 20 full case studies. Formative and summative assessment is advisable and the number of taught cases should not be the sole determinant of competence. The review also highlights differences in recommendations from major national gastroenterology societies. Finally, the authors discuss areas of unmet needs in teaching and learning for capsule endoscopy.
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Affiliation(s)
- Apostolos Koffas
- Gastroenterology Department, University Hospital of Larisa, Mezourlo, Larisa 41110, Greece
| | | | - Owen Epstein
- Centre for Gastroenterology, Royal Free Hospital, Pond St, London NW3 2QG, United Kingdom
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15
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Ohmiya N, Hotta N, Mitsufuji S, Nakamura M, Omori T, Maeda K, Okuda K, Yatsuya H, Tajiri H. Multicenter feasibility study of bowel preparation with castor oil for colon capsule endoscopy. Dig Endosc 2019; 31:164-172. [PMID: 30102791 DOI: 10.1111/den.13259] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/09/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Extensive use of laxatives and incomplete excretion rates are problematic for colon capsule endoscopy (CCE). The aim of the present study was to determine the effectiveness of castor oil as a booster. METHODS At four Japanese hospitals, 319 examinees undergoing CCE were enrolled retrospectively. Before and after the introduction of castor oil, other preparation reagents were unchanged. RESULTS Of 319 examinees who underwent CCE, 152 and 167 examinees took regimens with castor oil (between November 2013 and June 2016) and without castor oil (between October 2015 and September 2017), respectively. Capsule excretion rates within its battery life in the groups with and without castor oil were 97% and 81%, respectively (P < 0.0001). Multivariate analysis showed that ages younger than 65 years (adjusted odds ratio [OR], 3.00; P = 0.0048), male gender (adjusted OR, 3.20; P = 0.0051), and use of castor oil (adjusted OR, 6.29; P = 0.0003) were predictors of capsule excretion within its battery life. Small bowel transit time was shorter and total volume of lavage and fluid intake was lower with castor oil than without (P = 0.0154 and 0.0013, respectively). Overall adequate cleansing level ratios with and without castor oil were 74% and 83%, respectively (P = 0.0713). Per-examinee sensitivity for polyps ≥6 mm with and without castor oil was 83% and 85%, respectively, with specificities of 80% and 78%, respectively. CONCLUSION Bowel preparation with castor oil was effective for improving capsule excretion rate and reducing liquid loading.
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Affiliation(s)
- Naoki Ohmiya
- Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naoki Hotta
- Department of Internal Medicine, Masuko Memorial Hospital, Nagoya, Japan
| | - Shoji Mitsufuji
- Department of Gastroenterology, Kyoto Kujo Hospital, Kyoto, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takafumi Omori
- Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kohei Maeda
- Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kotaro Okuda
- Department of Gastroenterology, Kyoto Kujo Hospital, Kyoto, Japan
| | - Hiroshi Yatsuya
- Public Health, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hisao Tajiri
- Department of Innovative Interventional Endoscopy Research, The Jikei University School of Medicine, Tokyo, Japan
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16
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Buijs MM, Kroijer R, Kobaek-Larsen M, Spada C, Fernandez-Urien I, Steele RJ, Baatrup G. Intra and inter-observer agreement on polyp detection in colon capsule endoscopy evaluations. United European Gastroenterol J 2018; 6:1563-1568. [PMID: 30574327 DOI: 10.1177/2050640618798182] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/02/2018] [Indexed: 12/26/2022] Open
Abstract
Background Colon capsule endoscopy is a promising technique for evaluation of the colon, but its reproducibility is still unknown. Objective This study assesses intra and inter-observer agreement in evaluations of colon capsule endoscopy videos. Methods Forty-two complete colon capsule endoscopy investigations were analysed by three experts and two beginners. Intra-observer agreement was assessed in paired readings of two experts and two beginners. Agreement was determined by the intraclass correlation coefficient: poor (<0.5), moderate (0.5-0.75), good (0.75-0.9) and excellent (>0.9). Results Agreement on 'indication for a following colonoscopy' based on the number and size of detected polyps and bowel cleansing quality was poor among all observers. Agreement among experts on the detection of large polyps and number of polyps was moderate, but agreement on bowel cleansing quality was poor. Beginners were in moderate agreement with the experts on polyp detection. Intra-observer agreement in experts was moderate to excellent for the detection of large polyps (≥10 mm), excellent for the number of polyps, and poor to moderate for bowel cleansing quality. Intra-observer agreement in beginners was poor to moderate for all variables. Conclusions This study shows a poor agreement on 'indication for a following colonoscopy', but a high intra and inter-observer agreement for polyp detection among experts, as well as a moderate agreement between beginners and experts.Trial registration: NCT02303756.
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Affiliation(s)
| | - Rasmus Kroijer
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Cristiano Spada
- Digestive Endoscopy Unit, Catholic University, Rome, Italy.,Digestive Endoscopy Unit, Poliambulanza Foundation, Brescia, Italy
| | | | - Robert Jc Steele
- Department of Surgery, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
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17
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Abstract
Colon capsule endoscopy (CCE) is designed for direct visualization of the colonic mucosa through passive propulsion. The role of CCE in the detection of colonic polyps has been extensively evaluated. As mucosal healing has emerged as a pivotal target for treatment of inflammatory bowel disease (IBD), there is increasing data to suggest that CCE can also be used in the monitoring of mucosal inflammation in patients with active IBD, particularly in ulcerative colitis (UC) and Crohn's disease (CD). Despite advantages such as its non-invasive nature, patient's comfort, safety, and access to anatomical regions not easily reached by conventional endoscopy, CE has limitations including the lack of ability to obtain biopsies or therapeutic capabilities and no control over movement. In this review, the role and diagnostic value of CCE on diagnosis and monitoring of UC and CD patients, its safety and limitations are discussed.
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Affiliation(s)
- Jiao Li
- Department of Medicine, University of Hong Kong, Hong Kong, China.,Department of Gastroenterology, Third People's Hospital of Chengdu, Chengdu, Sichuan Province, China
| | - Wai K Leung
- Department of Medicine, University of Hong Kong, Hong Kong, China
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18
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Hong SN, Kang SH, Jang HJ, Wallace MB. Recent Advance in Colon Capsule Endoscopy: What's New? Clin Endosc 2018; 51:334-343. [PMID: 30078307 PMCID: PMC6078933 DOI: 10.5946/ce.2018.121] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 07/23/2018] [Accepted: 07/23/2018] [Indexed: 12/11/2022] Open
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 CCEcan be performed painlessly without bowel air insufflation, the need for vigorous bowel preparation and other technical limitationsexist. Due to such limitations, CCE has not replaced conventional colonoscopy. In this review, we discuss historical and recentadvances in CCE including technical issues, ideal bowel preparation, indications and contraindications and highlight further technicaladvancements and clinical studies which are needed to develop CCE as a potential diagnostic tool.
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Affiliation(s)
- Sung Noh Hong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-Hyung Kang
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyun Joo Jang
- Division of Gastroenterology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Michael B. Wallace
- Department of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, FL, USA
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19
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Buijs MM, Kobaek-Larsen M, Kaalby L, Baatrup G. Can coffee or chewing gum decrease transit times in Colon capsule endoscopy? A randomized controlled trial. BMC Gastroenterol 2018; 18:95. [PMID: 29940864 PMCID: PMC6020226 DOI: 10.1186/s12876-018-0824-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/14/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A high rate of complete colon capsule endoscopy (CCE) investigations is required for a more widespread use of CCE. The objective of this study was to assess if coffee or chewing gum can increase excretion of the colon capsule within battery life time (excretion rate). METHODS One hundred eighty six screening participants with a positive immunochemical fecal occult blood test were included in this single-centre randomized controlled trial with blinding of the investigators to the randomization. Participants received instant coffee, chewing gum or nothing in addition to the standard bowel preparation. RESULTS The intention was to include 57 participants in the coffee group, 61 in the chewing gum group and 60 in the control group, on 8 participants data were missing. A total of 165 participants were included in a per protocol analysis. Exclusion was due to not receiving the allocated intervention (8 coffee, 4 chewing gum) and technical failure of the capsule (1 coffee). The excretion rate was 58% in the coffee group (n = 48), 63% in the chewing gum group (n = 57) and 55% in the control group (n = 60, p > 0.2). Transit times were similar in all groups. The excretion rate was low in participants who had transit times over 10 h (14%). A strong correlation was found between adequate cleansing and excretion of the capsule. There were no serious adverse events related to the interventions or CCE investigations. CONCLUSIONS Chewing gum and coffee did not improve excretion rate in this study. An effect of chewing gum could not be proven, possibly due to sample size. Since chewing gum might improve excretion rates, is cheap and has no known side effects, it needs to be considered in future bowel preparation trials for CCE. TRIAL REGISTRATION NCT02303756 , registered on December 1st 2014.
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Affiliation(s)
- Maria Magdalena Buijs
- Department of Clinical Research, University of Southern Denmark, Winsløwsparken 19, 3rd floor, 5000, Odense, Denmark. .,Department of Surgery, Odense University Hospital, Baagøes Allé 15, Forskningshus, 5700, Svendborg, Denmark.
| | - Morten Kobaek-Larsen
- Department of Clinical Research, University of Southern Denmark, Winsløwsparken 19, 3rd floor, 5000, Odense, Denmark
| | - Lasse Kaalby
- Department of Clinical Research, University of Southern Denmark, Winsløwsparken 19, 3rd floor, 5000, Odense, Denmark
| | - Gunnar Baatrup
- Department of Clinical Research, University of Southern Denmark, Winsløwsparken 19, 3rd floor, 5000, Odense, Denmark.,Department of Surgery, Odense University Hospital, Baagøes Allé 15, Forskningshus, 5700, Svendborg, Denmark
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20
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Ota Y, Yamada A, Kobayashi Y, Niikura R, Shimpoh T, Narita A, Yoshida S, Suzuki N, Watabe H, Hirata Y, Ishihara S, Sunami E, Watanabe T, Koike K. Diagnostic capability of colon capsule endoscopy for advanced colorectal cancer: A pilot study. Dig Endosc 2017; 29:695-701. [PMID: 28295697 DOI: 10.1111/den.12862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 03/06/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Colon capsule endoscopy (CCE) is a safe and effective method for detecting lesions in the colon. However, the sensitivity of CCE in detecting advanced colorectal cancer (CRC) has not been sufficiently evaluated. Therefore, the aim of the present study was to assess the sensitivity of CCE in detecting advanced CRC. METHODS Patients previously diagnosed with advanced CRC by conventional colonoscopy underwent CCE. Primary outcome measure was the sensitivity of CCE in detecting advanced CRC per patient and per lesion. Secondary parameters measured were the sensitivity of CCE in detecting polyps ≥6 mm and ≥10 mm in size in a per-lesion analysis and the safety of CCE. RESULTS Of the 21 advanced CRC lesions in 20 patients, 17 were detected by CCE. The per-patient and per-lesion sensitivities of CCE for detecting advanced CRC lesions were 85% (95% confidence interval [CI]: 62-97%) and 81% (95% CI: 58-95%), respectively. All advanced CRC lesions were diagnosed in the accessible region by CCE while the capsule was still functional. A significant association was found between incomplete CCE and failure to diagnose advanced CRC. No severe adverse events occurred. CONCLUSION The diagnostic capability of CCE in detecting advanced CRC was limited in cases of procedure incompletion. Refining procedures to increase CCE procedure completion rates are required to enhance CRC detection.
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Affiliation(s)
- Yumiko Ota
- Department of Gastroenterology, The University of Tokyo, Tokyo, Japan
| | - Atsuo Yamada
- Department of Gastroenterology, The University of Tokyo, Tokyo, Japan
| | - Yuka Kobayashi
- Department of Gastroenterology, The University of Tokyo, Tokyo, Japan
| | - Ryota Niikura
- Department of Gastroenterology, The University of Tokyo, Tokyo, Japan
| | - Takayuki Shimpoh
- Department of Gastroenterology, The University of Tokyo, Tokyo, Japan
| | - Akiko Narita
- Department of Gastroenterology, The University of Tokyo, Tokyo, Japan
| | - Shuntaro Yoshida
- Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.,Department of Endoscopy and Endoscopic Surgery, The University of Tokyo, Tokyo, Japan
| | - Nobumi Suzuki
- Department of Gastroenterology, The Institute for Adult Diseases Asahi Life Foundation, Tokyo, Japan
| | | | - Yoshihiro Hirata
- Department of Gastroenterology, The University of Tokyo, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Eiji Sunami
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiaki Watanabe
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, The University of Tokyo, Tokyo, Japan
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21
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Zhou J, Tang X, Wang J, Chen Z, Wang X, Jiang B. Feasibility of a novel low-volume and sodium phosphate-free bowel preparation regimen for colon capsule endoscopy. Exp Ther Med 2017; 14:1739-1743. [PMID: 28810644 PMCID: PMC5525907 DOI: 10.3892/etm.2017.4664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 04/07/2017] [Indexed: 02/05/2023] Open
Abstract
Bowel preparation regimens for colon capsule endoscopy are not yet standardized since they are not well optimized. The aim of the present study was to evaluate the feasibility of a novel low-volume and sodium phosphate-free bowel preparation regimen for colon capsule endoscopy. A total of 31 patients were prospectively enrolled. In the novel regimen, on the day prior to examination, a low-fiber diet was permitted, 5 mg mosapride citrate was administered twice (1 h prior to lunch and supper) and 1 l polyethylene glycol was administered in the evening. On the day of the examination, an additional 1 l polyethylene glycol, 5 mg mosapride citrate and 200 mg simethicone were administered before capsule ingestion. Polyethylene glycol booster (0.5 l) was administered twice, at 1 and 4 h following capsule ingestion. Colon cleansing levels, ileocecal valve transit time and completion rate were evaluated. A total of 29 patients were included in the final analysis, 90% of whom achieved adequate preparation of the overall colon. Ileocecal valve transit time was 2.35±0.82 h and completion rate was 79.3%. The results revealed that the novel low-volume and sodium phosphate-free bowel preparation regimen for colon capsule endoscopy was feasible, with adequate colon cleansing and completion rates, and has the potential to be used as an alternative regimen.
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Affiliation(s)
- Jieqiong Zhou
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
- Department of Gastroenterology, Beijing Tsinghua Chang Gung Hospital, Tsinghua University, Beijing 102218, P.R. China
| | - Xiaowei Tang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
- Department of Gastroenterology, Beijing Tsinghua Chang Gung Hospital, Tsinghua University, Beijing 102218, P.R. China
| | - Jing Wang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Zhenyu Chen
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xinying Wang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Bo Jiang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
- Department of Gastroenterology, Beijing Tsinghua Chang Gung Hospital, Tsinghua University, Beijing 102218, P.R. China
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22
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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. [PMID: 28052292 DOI: 10.1159/000452367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM The manner in which colorectal lesions are being detected with PillCam COLON2 capsule endoscopy (CCE2) has markedly improved in recent days. However, limited data are available on CCE2 for detecting laterally spreading tumors (LSTs). The aim of this study was to compare CCE2 with optical colonoscopy (OC), which is currently the gold standard used in the detection of LSTs. METHODS We performed a prospective, single-academic center study comparing CCE2 with OC in patients with LSTs diagnosed using OC, which was performed during the 3-month period prior to CCE2. We focused on the sensitivity and specificity of CCE2 for detecting LSTs. LSTs were classified into the LST-granular type (LST-G) or the LST-non-granular type (LST-NG). RESULTS Thirty patients (mean age 59.5 years) were enrolled. Of them, 21 LSTs (7 LST-Gs and 14 LST-NGs) were evaluated in this study. The mean diameter of the LSTs was 27 ± 15 mm (range 10-60 mm). Histopathological diagnoses of the LSTs were as follows: tubular adenoma, 12 cases (57%); sessile serrated adenoma/polyp (SSA/P), 4 cases (19%); Tis carcinoma, 1 case (5%); and T1 carcinoma, 4 cases (19 LSTs were found in the following locations: cecum, 1 case (5%); ascending colon, 6 cases (29%); transverse colon, 6 cases, (29%); descending colon, 1 case (5%); sigmoid colon, 3 cases (13%); and rectum, 4 cases (19%). The colon cleansing level was adequate in all cases. The sensitivity and specificity of CCE2 for detecting LSTs were 81 and 100% respectively. For detecting LST-Gs and LST-NGs, the sensitivity and specificity were 71 and 100%, and 86 and 100%, respectively. There were 4 false-negative cases (LST-G (18 mm), cecum; LST-G (20 mm), sigmoid colon; LST-NG (25 mm), transverse colon; LST-NG (20 mm), transverse colon). CONCLUSIONS The sensitivity for detecting LSTs is lower with CCE2 than it is with OC, especially for LSTs located on the right colon or for SSA/P.
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Affiliation(s)
- Atsushi Igawa
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Romero-Vázquez J, Caunedo-Álvarez Á, Belda-Cuesta A, Jiménez-García VA, Pellicer-Bautista F, Herrerías-Gutiérrez JM. Extracolonic findings with the PillCam Colon: is panendoscopy with capsule endoscopy closer? Endosc Int Open 2016; 4:E1045-E1051. [PMID: 27747276 PMCID: PMC5063639 DOI: 10.1055/s-0042-115406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 07/29/2016] [Indexed: 02/08/2023] Open
Abstract
Background and study aims: Colon capsules display images from the moment they are ingested, making the study of other extracolonic areas possible. The aim of this study was to analyze the significance of these extracolonic findings. Patients and methods: In this single-center, prospective study, 165 patients underwent colon capsule endoscopy (CCE) between September 2009 and October 2012 to rule out colonic pathology. Images were recorded, without interruptions, from the moment the capsule was ingested until its battery ran out. The study was deemed complete when the capsule had traveled from the esophagus to excretion or until the hemorrhoidal plexus was observed. Results: CCE was used for colorectal cancer (CRC) screening (81.2 %), to investigate for chronic diarrhea (9.7 %) and chronic iron deficiency anemia (6.1 %), and for patients with incomplete colonoscopy (3.0 %). The capsule returned findings in the esophagus in 52.1 % of patients, in the stomach in 45.5 % of patients, and in the small bowel in 70.7 % of patients, with the findings being considered relevant in 4.9 %, 9.7 %, and 22.6 % of patients, respectively. The whole extent of the digestive tract was fully recorded in 86.1 % of patients and the Z line could be fully observed in 57.6 % of patients. There were no adverse events. Conclusions: CCE allows the recording of images from almost the whole extent of the digestive tract in most patients, enabling relevant pathologies to be identified in extracolonic areas, particularly the small bowel. Technical and procedural improvements are still necessary in order to achieve better observation of the stomach and esophagus.
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Affiliation(s)
- Javier Romero-Vázquez
- Gastroenterology Service, Virgen Macarena University Hospital, Seville, Spain,Corresponding author Javier Romero Vázquez, MD Gastroenterology ServiceVirgen Macarena University HospitalAvenida Dr. Fedriani s/nSeville 40171Spain+34-955-008805
| | | | - Alba Belda-Cuesta
- Gastroenterology Service, Virgen Macarena University Hospital, Seville, Spain
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24
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Carter D, Eliakim R. PillCam colon capsule endoscopy (PCCE) in colonic diseases. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:307. [PMID: 27668227 DOI: 10.21037/atm.2016.08.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diseases affecting the colon are common worldwide and can cause a major health problem. Colorectal cancer (CRC) as well as Inflammatory bowel diseases represent a major cause of morbidity and mortality in western countries. PillCam colon capsule endoscopy (PCCE) is a novel and promising technology that can be useful for the screening and monitoring of colonic diseases. In the recent years many articles examined the use of various versions of PCCE-the 1st and 2nd generation versus various other endoscopic or radiologic modalities both for detection of colonic polyps or cancer and in both ulcerative colitis (UC) and Crohn's disease. The aim of the current review is to provide up to date information regarding the use and usefulness of this method in these disease.
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Affiliation(s)
- Dan Carter
- Department of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rami Eliakim
- Department of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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25
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Han YM, Im JP. Colon Capsule Endoscopy: Where Are We and Where Are We Going. Clin Endosc 2016; 49:449-453. [PMID: 27653441 PMCID: PMC5066410 DOI: 10.5946/ce.2016.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/07/2016] [Indexed: 12/11/2022] Open
Abstract
Colon capsule endoscopy (CCE) is a noninvasive technique for diagnostic imaging of the colon. It does not require air inflation or sedation and allows minimally invasive and painless colonic evaluation. The role of CCE is rapidly evolving; for example, for colorectal screening (colorectal cancer [CRC]) in average-risk patients, in patients with an incomplete colonoscopy, in patients refusing a conventional colonoscopy, and in patients with contraindications for conventional colonoscopy. In this paper, we comprehensively review the technical characteristics and procedure of CCE and compare CCE with conventional methods such as conventional colonoscopy or computed tomographic colonography. Future expansion of CCE in the area of CRC screening for the surveillance of polyps and adenomatous lesions and for assessment of inflammatory bowel disease is also discussed.
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Affiliation(s)
- Yoo Min Han
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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26
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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; 51:579-85. [PMID: 26525538 DOI: 10.1007/s00535-015-1134-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/10/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Training for colon capsule endoscopy (CCE) procedures is currently performed as a lecture and hands-on seminar. The aims of this pilot study were to assess the utility of an electronic learning system for CCE (ELCCE) designed for the Japanese Association for Capsule Endoscopy using an objective scoring engine, and to evaluate the efficacy of ELCCE on the acquisition of CCE reading competence. METHODS ELCCE is an Internet-based learning system with the following steps: step 1, introduction; step 2, CCE reading competence assessment test (CCAT), which evaluates the competence of CCE reading prior to training; step 3, learning reading theory; step 4, training with guidance; step 5, training without guidance; step 6, final assessment; and step 7, the same as step 2. The CCAT, step 5 and step 6 were scored automatically according to: lesion detection, diagnosis (location, size, shape of lesion), management recommendations, and quality of view. Ten trainee endoscopists were initially recruited (cohort 1), followed by a validating cohort of 11 trainee endoscopists (cohort 2). RESULTS All but one participant finished ELCCE training within 7 weeks. In step 6, accuracy ranged from 53 to 98 % and was not impacted by step 2 pretest scores. The average CCAT scores significantly increased between step 2 pretest and step 7 in both cohorts, from 42 ± 18 % to 79 ± 15 % in cohort 1 (p = 0.0004), and from 52 ± 15 % to 79 ± 14 % in cohort 2 (p = 0.0003). CONCLUSIONS ELCCE is useful and effective for improving CCE reading competence.
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Affiliation(s)
| | - Tetsuya Nakamura
- Department of Medical Informatics, School of Medicine, Dokkyo Medical University, 880 Kita-Kobayashi, Mibu, Tochigi, 321-0293, Japan.
| | - Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuo Kakugawa
- Center Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Sadaharu Nouda
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Akira Terano
- Dokkyo Group of Academic Institutions, Saitama, Japan
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Akyüz Ü, Yılmaz Y, İnce AT, Kaya B, Pata C. Diagnostic Role of Colon Capsule Endoscopy in Patients with Optimal Colon Cleaning. Gastroenterol Res Pract 2016; 2016:2738208. [PMID: 27066070 PMCID: PMC4811092 DOI: 10.1155/2016/2738208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 02/21/2016] [Indexed: 12/22/2022] Open
Abstract
Background. Colon capsule endoscopy (CCE) is a diagnostic test with relatively rare usage. In this study, we aimed to evaluate both the optimal cleaning regimen for CCE and the diagnostic value of test in the study group. Methods. A total of 62 patients were enrolled in this study. In the first step, 3 different colon preparing regimens were given to 30 patients [Group A: 3 days of liquid diet, sodium phosphate (NaP) (90 mL), and NaP enema; Group B: 3 days of liquid diet, 4 L of polyethylene glycol (PEG), and metoclopramide; Group C: 3 days of liquid diet, 4 L of PEG, NaP (45 mL), and bisacodyl after capsule ingestion] (10 patients in each group). The other consecutive 32 patients were cleaned with the best regimen which was NaP + PEG and CCE was performed. The results of CCE were controlled with colonoscopy in 28 patients. Results. Group C had the highest cleaning score, compared with the other groups (2.2 ± 0.4 versus 2.7 ± 0.4 versus 3.7 ± 0.4, p value = 0.000). The CCE findings were as follows in 28 patients who were also examined with colonoscopy: polyp (range: 5-10 mm) in 6 patients, internal hemorrhoids in 3 patients, angiodysplasia in 1 patient, diverticula in 1 patient, and ulcerative colitis in 1 patient. The sensitivity, specificity, PPV, and NPV of CCE were 100%, 92%, 93%, and 100%, respectively. Conclusions. Low dosage NaP combined with PEG provides optimal bowel preparation for CCE. CCE appears to be a highly sensitive diagnostic modality for detecting colonic pathologies.
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Affiliation(s)
- Ümit Akyüz
- Department of Gastroenterology, Yeditepe University, Kozyatağı, 34752 Istanbul, Turkey
| | - Yusuf Yılmaz
- Department of Gastroenterology, Marmara University, Maltepe, 81090 Istanbul, Turkey
| | - Ali Tüzün İnce
- Department of Gastroenterology, Bezm-i Alem University, Fatih, 34590 Istanbul, Turkey
| | - Bülent Kaya
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Ataşehir, 34752 Istanbul, Turkey
| | - Cengiz Pata
- Department of Gastroenterology, Yeditepe University, Kozyatağı, 34752 Istanbul, Turkey
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Adrián-de-Ganzo Z, Alarcón-Fernández O, Ramos L, Gimeno-García A, Alonso-Abreu I, Carrillo M, Quintero E. Uptake of Colon Capsule Endoscopy vs Colonoscopy for Screening Relatives of Patients With Colorectal Cancer. Clin Gastroenterol Hepatol 2015; 13:2293-301.e1. [PMID: 26133904 DOI: 10.1016/j.cgh.2015.06.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/11/2015] [Accepted: 06/09/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The efficacy of screening colonoscopy in first-degree relatives (FDRs) of patients with colorectal cancer (CRC) is limited by suboptimal uptake. We compared screening uptake of colon capsule endoscopy (CCE) vs colonoscopy in this population. METHODS We performed a prospective study of 329 asymptomatic FDRs of patients with CRC who were randomly assigned to groups examined by CCE (PillCam, second generation; n = 165) or colonoscopy (n = 164) at a tertiary hospital in Spain from July 2012 through December 2013. Crossover was permitted for patients who did not wish to undergo the assigned procedure. Subjects assigned to CCE who had a significant lesion (polyp ≥ 10 mm, >2 polyps of any size, or CRC) were invited to undergo colonoscopy. RESULTS One hundred twenty subjects in the CCE group and 113 in the colonoscopy group were eligible for inclusion. In the intention-to-screen analysis, uptake was similar between groups (55.8% CCE vs 52.2% colonoscopy; odds ratio [OR], 0.86; 95% confidence interval [CI], 0.51-1.44; P = .57); 57.4% of subjects crossed over from the CCE group, and 30.2% crossed over from the colonoscopy group (OR, 3.11; 95% CI, 1.51-6.41; P = .002). Unwillingness to repeat bowel preparation in the case of a positive result was the main reason that subjects assigned to the CCE group crossed over; fear of colonoscopy was the reason that most patients in this group crossed over. A significant lesion was detected in 14 subjects (11.7%) in the CCE group and 13 subjects (11.5%) in the colonoscopy group (OR, 1.02; 95% CI, 0.45-2.26; P = .96). CONCLUSIONS In a prospective study, similar numbers of FDRs of patients with CRC assigned to undergo CCE or colonoscopy agreed to participate, but most preferred to undergo colonoscopy. CCE was as effective as colonoscopy in detecting significant lesions; it could be a valid rescue strategy for subjects who reject screening colonoscopy. ClinicalTrials.gov number: NCT01557101.
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Affiliation(s)
- Zaida Adrián-de-Ganzo
- Servicio de Gastroenterología, Hospital Universitario de Canarias; Instituto Universitario de Tecnologías Biomédicas (ITB), Centro de Investigación Biomédica de Canarias (CIBICAN); and Departamento de Medicina Interna, Universidad de La Laguna, Tenerife, Spain
| | - Onofre Alarcón-Fernández
- Servicio de Gastroenterología, Hospital Universitario de Canarias; Instituto Universitario de Tecnologías Biomédicas (ITB), Centro de Investigación Biomédica de Canarias (CIBICAN); and Departamento de Medicina Interna, Universidad de La Laguna, Tenerife, Spain
| | - Laura Ramos
- Servicio de Gastroenterología, Hospital Universitario de Canarias; Instituto Universitario de Tecnologías Biomédicas (ITB), Centro de Investigación Biomédica de Canarias (CIBICAN); and Departamento de Medicina Interna, Universidad de La Laguna, Tenerife, Spain
| | - Antonio Gimeno-García
- Servicio de Gastroenterología, Hospital Universitario de Canarias; Instituto Universitario de Tecnologías Biomédicas (ITB), Centro de Investigación Biomédica de Canarias (CIBICAN); and Departamento de Medicina Interna, Universidad de La Laguna, Tenerife, Spain
| | - Inmaculada Alonso-Abreu
- Servicio de Gastroenterología, Hospital Universitario de Canarias; Instituto Universitario de Tecnologías Biomédicas (ITB), Centro de Investigación Biomédica de Canarias (CIBICAN); and Departamento de Medicina Interna, Universidad de La Laguna, Tenerife, Spain
| | - Marta Carrillo
- Servicio de Gastroenterología, Hospital Universitario de Canarias; Instituto Universitario de Tecnologías Biomédicas (ITB), Centro de Investigación Biomédica de Canarias (CIBICAN); and Departamento de Medicina Interna, Universidad de La Laguna, Tenerife, Spain
| | - Enrique Quintero
- Servicio de Gastroenterología, Hospital Universitario de Canarias; Instituto Universitario de Tecnologías Biomédicas (ITB), Centro de Investigación Biomédica de Canarias (CIBICAN); and Departamento de Medicina Interna, Universidad de La Laguna, Tenerife, Spain.
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Saito Y, Saito S, Oka S, Kakugawa Y, Matsumoto M, Aihara H, Watari I, Aoyama T, Nouda S, Kuramoto T, Watanabe K, Ohmiya N, Higuchi K, Goto H, Arakawa T, Tanaka S, Tajiri H. Evaluation of the clinical efficacy of colon capsule endoscopy in the detection of lesions of the colon: prospective, multicenter, open study. Gastrointest Endosc 2015; 82:861-9. [PMID: 25936450 DOI: 10.1016/j.gie.2015.02.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 02/03/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Colon capsule endoscopy (CCE) is a new procedure for colon imaging. Limited information is available regarding visualization of flat colon lesions and patient acceptability in Japan. OBJECTIVE The aims of this study were to evaluate the sensitivity of CCE in detecting polyps and other lesions compared with optical colonoscopy (OC) and to evaluate its safety and acceptability in a cohort of Japanese patients. DESIGN A prospective, open-label, clinical study in Japan. SETTING Multicenter. PATIENTS Patients referred for OC because of personal history of polyps ≥6 mm or any other colon lesion that required endoscopic or surgical treatment. INTERVENTIONS CCE followed by therapeutic colonoscopy. MAIN OUTCOME MEASUREMENTS The primary endpoint was per-patient sensitivity of CCE in detecting significant colon lesion. The secondary endpoints were CCE safety and patient acceptability. RESULTS Sixty-six of the 72 patients enrolled in the study were evaluated for efficacy. The per-patient sensitivity was 94% (95% confidence interval [CI], 88.2%-99.7%). The per-polyp sensitivity was 86.6% (95% CI, 81.3%-91.9%) when pathology-confirmed polyps were considered true positives. There were no adverse events related to CCE, and the acceptability of CCE was high. LIMITATIONS All patients had previously confirmed colon lesions, which may have falsely elevated the sensitivity of CCE. CONCLUSION CCE had a high sensitivity for detecting significant colon lesions. CCE was safe and had a high level of patient acceptability. ( CLINICAL TRIAL REGISTRATION NUMBER University Hospital Medical Information Network, UMIN000007258.).
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Affiliation(s)
- Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shoichi Saito
- Division of Gastroenterology and Hepatology/Endoscopy, Tokyo Jikei University School of Medicine, Tokyo, Japan
| | - Shiro Oka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Yasuo Kakugawa
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Minori Matsumoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Aihara
- Division of Gastroenterology and Hepatology/Endoscopy, Tokyo Jikei University School of Medicine, Tokyo, Japan
| | - Ikue Watari
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Taiki Aoyama
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Sadaharu Nouda
- The 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Takanori Kuramoto
- The 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kenji Watanabe
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Naoki Ohmiya
- Department of Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan (Presently Educational Corporation Fujita School, Fujita Health University Hospital)
| | - Kazuhide Higuchi
- The 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Hidemi Goto
- Department of Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan (Presently Educational Corporation Fujita School, Fujita Health University Hospital)
| | - Tetsuo Arakawa
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Hisao Tajiri
- Division of Gastroenterology and Hepatology/Endoscopy, Tokyo Jikei University School of Medicine, Tokyo, Japan
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Ota K, Nouda S, Takeuchi T, Iguchi M, Kojima Y, Kuramoto T, Inoue T, Shindo Y, Uesugi K, Fujito Y, Nishihara H, Ohtsuka N, Higuchi K, Team Mermaid. What Kind of Capsule Endoscope Is Suitable for a Controllable Self-Propelling Capsule Endoscope? Experimental Study Using a Porcine Stomach Model for Clinical Application (with Videos). PLoS One 2015; 10:e0139878. [PMID: 26447694 PMCID: PMC4598012 DOI: 10.1371/journal.pone.0139878] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 09/07/2015] [Indexed: 12/22/2022] Open
Abstract
Background We have been developing the Self-Propelling Capsule Endoscope (SPCE) that allows for controllability from outside of the body and real-time observation. What kind of capsule endoscope (CE) is suitable for a controllable SPCE is unclear and a very critical point for clinical application. We compared observing ability of three kinds of SPCEs with different viewing angles and frame rates. Methods Eleven buttons were sewed in an excised porcine stomach. Four examiners controlled the SPCE using PillCamSB2, -ESO2, and -COLON2 (Given Imaging Ltd., Israel), for 10 minutes each with the aim of detecting as many buttons and examining them as closely as possible. The ability to find lesions was assessed based on the number of detected buttons. The SPCE-performance score (SPS) was used to evaluate the ability to examine the lesions in detail. Results The SPCE-ESO2, -COLON2, and -SB2 detected 11 [interquartile range (IQR): 0], 10.5 (IQR, 0.5), and 8 (IQR, 1.0) buttons, respectively. The SPCE-ESO2 and -COLON2 had a significantly better ability to detect lesions than the -SB2 (p < 0.05). The SPCE-ESO2, -COLON2, and -SB2 had significantly different SPS values of 22 (IQR, 0), 16.5 (IQR, 1.5), and 14 (IQR, 1.0), respectively (p < 0.05 for all comparisons; SPCE-SB2 vs. -ESO2, -SB2 vs. -COLON2, and -ESO2 vs. -COLON2). Conclusions PillCamESO2 is most suitable in different three CEs for SPCE for examining lesions in detail of the stomach.
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Affiliation(s)
- Kazuhiro Ota
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
- * E-mail:
| | - Sadaharu Nouda
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Toshihisa Takeuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Munetaka Iguchi
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yuichi Kojima
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Takanori Kuramoto
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Takuya Inoue
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yasunori Shindo
- Faculty of Science and Technology, Ryukoku University, Seta, Shiga, Japan
| | | | | | | | | | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
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Parker CE, Spada C, McAlindon M, Davison C, Panter S. Capsule endoscopy--not just for the small bowel: a review. Expert Rev Gastroenterol Hepatol 2015; 9:79-89. [PMID: 25484107 DOI: 10.1586/17474124.2014.934357] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Video capsule endoscopy is being increasingly used to investigate the esophagus and colon as well as the small bowel. With the advancement of technology used in capsule endoscopy there have been marked improvements in diagnostic rates for colon capsule endoscopy in the detection of colonic polyps and colorectal cancer. It is also being increasingly used in the field if inflammatory bowel disease to investigate for mucosal inflammation and could potentially be used to assess mucosal healing. It also has role in completing the evaluation of colonic pathology in those in whom colonoscopy is incomplete. Esophageal capsule is preferred by patients over esophagogastroduodenoscopy (EGD) but as yet does not rival EGD in terms of diagnostic accuracy however the advent of magnetically steerable capsules may improve this. This review covers advances in the field of colon and esophageal capsule endoscopy; it covers diagnostic capabilities of these 2 tools as well as technical aspects of both procedures and preparation.
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Affiliation(s)
- Clare Elizabeth Parker
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Tyneside District Hospital Harton Lane, South Shields NE34 0PL, UK
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Hosoe N, Naganuma M, Ogata H. Current status of capsule endoscopy through a whole digestive tract. Dig Endosc 2015; 27:205-215. [PMID: 25208463 DOI: 10.1111/den.12380] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 09/05/2014] [Indexed: 02/06/2023]
Abstract
More than a decade has passed since small-bowel capsule endoscopy (CE) was first reported. Small-bowel CE is a non-invasive tool that allows visualization of the entire small-intestinal mucosa and facilitates detection of small-intestinal abnormalities. Several studies have shown benefit of small-bowel CE for certain disorders. Because it is non-invasive, CE has been applied to other organs including the esophagus, stomach, and colon. The main indications for esophageal CE (ECE) are screening for gastroesophageal reflux disease/Barrett's esophagus, and esophageal varices. However, the clinical benefit of ECE is unconfirmed. Magnetically guided CE (MGCE) was developed to visualize the gastric mucosa. MGCE is a new concept with room for improvement of capsule navigation and the preparation protocol. Recently, two new small-bowel CE tools were released. First-generation colon CE (CCE-1) has moderate sensitivity and specificity compared with colonoscopy for colorectal neoplasia surveillance. To obtain higher accuracy, a second-generation CCE (CCE-2) was developed with a high sensitivity for detecting clinically relevant polypoid lesions. A possible application of CCE is for inflammatory bowel disease. In the near future, CE may include diagnostic and therapeutic functions such as magnifying endoscopy systems, targeted biopsy forceps, and drug delivery systems.
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Affiliation(s)
- Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
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Bouchard S, Ibrahim M, Gossum AV. Video capsule endoscopy: perspectives of a revolutionary technique. World J Gastroenterol 2014; 20:17330-17344. [PMID: 25516644 PMCID: PMC4265591 DOI: 10.3748/wjg.v20.i46.17330] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 07/25/2014] [Accepted: 09/12/2014] [Indexed: 02/06/2023] Open
Abstract
Video capsule endoscopy (VCE) was launched in 2000 and has revolutionized direct endoscopic imaging of the gut. VCE is now a first-line procedure for exploring the small bowel in cases of obscure digestive bleeding and is also indicated in some patients with Crohn's disease, celiac disease, and polyposis syndrome. A video capsule has also been designed for visualizing the esophagus in order to detect Barrett's esophagus or esophageal varices. Different capsules are now available and differ with regard to dimensions, image acquisition rate, battery life, field of view, and possible optical enhancements. More recently, the use of VCE has been extended to exploring the colon. Within the last 5 years, tremendous developments have been made toward increasing the capabilities of the colon capsule. Although colon capsule cannot be proposed as a first-line colorectal cancer screening procedure, colon capsule may be used in patients with incomplete colonoscopy or in patients who are unwilling to undergo colonoscopy. In the near future, new technological developments will improve the diagnostic yield of VCE and broaden its therapeutic capabilities.
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Abstract
PURPOSE OF REVIEW Video capsule endoscopy, which was initially developed for exploring the small bowel, has been adapted for investigating the colon. This review summarizes recent developments in colon capsule technology as well as indications for its use. RECENT FINDINGS Second-generation PillCam colon capsule endoscopy (CCE-2) has been recently developed and has significantly improved the sensitivity and specificity of colon capsules for detecting polyps and/or tumors in patients with suspected or known colonic lesions. The use of CCE-2 has been shown to be of value in patients with incomplete standard colonoscopy. The use of CCE-2 has also been investigated in patients with ulcerative colitis and in outpatient settings. Several trials have tried to simplify the colon preparation regimen. SUMMARY Colon capsule endoscopy is a novel technique for exploring the colon. CCE-2 has improved the diagnostic capability of this noninvasive method. There is still room for improvement and simplification of colon preparation regimens. Apart from detection of polyps or neoplasms, colon capsule endoscopy has also been assessed in patients with inflammatory bowel disease.
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Usui S, Hosoe N, Matsuoka K, Kobayashi T, Nakano M, Naganuma M, Ishibashi Y, Kimura K, Yoneno K, Kashiwagi K, Hisamatsu T, Inoue N, Serizawa H, Hibi T, Ogata H, Kanai T. Modified bowel preparation regimen for use in second-generation colon capsule endoscopy in patients with ulcerative colitis. Dig Endosc 2014; 26:665-672. [PMID: 24666340 DOI: 10.1111/den.12269] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/05/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM We have reported that second-generation colon capsule endoscopy (CCE-2) might be feasible for assessing the severity of mucosal inflammation in ulcerative colitis (UC). However, because of the low rate (69%) of complete evaluation of the colon and owing to inadequate cleansing. We believe that the method of bowel preparation could be improved by reducing volume. In the present study, we attempted to improve the colon-cleansing regimen in order to optimize the usefulness of CCE-2 in the management of UC patients. METHODS Twenty patients with histologically confirmed UC were enrolled. Patients took a maximum 2.2 L lavage solution (polyethylene glycol solution and magnesium citrate) in two or three divided doses. To assess the effectiveness of the modified bowel preparation regimen, we evaluated the rate of total colonobservation, the effectiveness of bowel cleansing, andinterobserver agreement in assessing UC disease activity. We used a four-point grading scale (poor, fair, good, and excellent) for evaluating the quality of bowel cleansing. Matts' endoscopic score was used to evaluate disease activity. RESULTS The rate of total colon observation was 85%, and 15 patients (75%) excreted the CCE-2 within 8 h. The proportion of excellent plus good cleansing was approximately 60%. There was a substantial interobserver agreement (κ = 0.777) in assessment of overall cleansing, which was still substantial at the fair cleansing level (κ = 0.700). CONCLUSION Using CCE-2, the modified bowel preparation regimen, with reduced volume has the potential to succeed in the evaluation of mucosal severity in UC.
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Affiliation(s)
- Shingo Usui
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
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Singhal S, Nigar S, Paleti V, Lane D, Duddempudi S. Bowel preparation regimens for colon capsule endoscopy: a review. Therap Adv Gastroenterol 2014; 7:115-22. [PMID: 24790642 PMCID: PMC3968815 DOI: 10.1177/1756283x13504730] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Colon capsule endoscopy (CCE) is being actively evaluated as an emerging complementary or alternative procedure for evaluation of the colon. The yield of CCE is significantly dependent on the quality of bowel preparation. In addition to achieving a stool-free colon the bowel preparation protocols need to decrease bubble effect and aid propulsion of the capsule. An extensive English literature search was done using PubMed with search terms of colon capsule endoscopy, PillCam and bowel preparation. Full-length articles which met the criteria were included for review. A total of 12 studies including 1149 patients were reviewed. There was significant variability in the type of bowel preparation regimens. Large-volume (3-4 liters) polyethylene glycol (PEG) was the most widely used laxative. Lower volumes of PEG showed comparable results but larger studies are needed to determine efficacy. Sodium phosphate was used as an effective booster in most studies. Magnesium citrate and ascorbic acid are emerging as promising boosters to replace sodium phosphate when it is contraindicated. The potential benefit of prokinetics needs further evaluation. Over the past decade there has been significant improvement in the bowel preparation regimens for CCE. Further experience and studies are likely to standardize the bowel preparation regimens before CCE is adopted into routine clinical practice.
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Affiliation(s)
- Shashideep Singhal
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York Presbyterian Hospital, 5141 Broadway, New York, NY 10034, USA
| | - Sofia Nigar
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Brooklyn, New York, NY, USA
| | - Vani Paleti
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Brooklyn, New York, NY, USA
| | - Devin Lane
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Brooklyn, New York, NY, USA
| | - Sushil Duddempudi
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Brooklyn, New York, NY, USA
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Ramos L, Alarcón O, Adrian Z, Gimeno-García AZ, Nicolás-Pérez D, Jiménez-Sosa A, Quintero E. One-day versus two-day cleansing for colon capsule endoscopy: a prospective randomized pilot study. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:101-6. [PMID: 24388792 DOI: 10.1016/j.gastrohep.2013.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/15/2013] [Accepted: 10/22/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Standard bowel cleansing for colon capsule endoscopy (CCE) requires a liquid diet and bowel laxatives for at least 2 days, which is a major drawback of this procedure and affects tolerance and acceptability. OBJECTIVE To compare the quality of colon cleanliness achieved with one-day versus two-day bowel preparation in outpatients undergoing CCE. METHODS Patients were randomly assigned to one of two groups: group I (one-day schedule, n=20) received a fiber-free diet and 3 L of polyethylene glycol (PEG) on day 0; group II (two-day schedule, n=20) received a liquid diet and 3 L of PEG in the evening of day -1, and 1L of PEG in the early morning of day 0. In both groups, the patients received 15 mg bisacodyl on day -1 and one or two additional sodium phosphate (NaP) boosters following capsule ingestion. Each colon segment was assessed for cleanliness using a four-point grading scale (excellent=1, good=2, fair=3, and poor=4). For the final analysis, colon cleanliness was rated as adequate (good or excellent) or inadequate (fair or poor). RESULTS Overall colon cleanliness was adequate in 94% (CI 91-97) of patients in group I versus 80% (CI 72-88) in group II (P=0.27). No significant differences were observed in the per-segment quality of colon cleansing between the two groups. CCE reached the rectum in 80% (CI 73-87) of patients in group I versus 75% (CI 67-83) in group II (p=0.59). CONCLUSION The quality of colon cleanliness achieved with one-day bowel preparation is equivalent to that of the standard two-day schedule in patients undergoing CCE.
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Affiliation(s)
- Laura Ramos
- Department of Gastroenterology, Hospital Universitario de Canarias, Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - Onofre Alarcón
- Department of Gastroenterology, Hospital Universitario de Canarias, Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - Zaida Adrian
- Department of Gastroenterology, Hospital Universitario de Canarias, Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - Antonio Z Gimeno-García
- Department of Gastroenterology, Hospital Universitario de Canarias, Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - David Nicolás-Pérez
- Department of Gastroenterology, Hospital Universitario de Canarias, Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | | | - Enrique Quintero
- Department of Gastroenterology, Hospital Universitario de Canarias, Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, Spain.
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Ankri R, Peretz D, Motiei M, Sella-Tavor O, Popovtzer R. New optical method for enhanced detection of colon cancer by capsule endoscopy. NANOSCALE 2013; 5:9806-9811. [PMID: 23969635 DOI: 10.1039/c3nr02396f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PillCam®COLON capsule endoscopy (CE), a non-invasive diagnostic tool of the digestive tract, has dramatically changed the diagnostic approach and has become an attractive alternative to the conventional colonoscopy for early detection of colorectal cancer. However, despite the significant progress and non-invasive detection capability, studies have shown that its sensitivity and specificity is lower than that of conventional colonoscopy. This work presents a new optical detection method, specifically tailored to colon cancer detection and based on the well-known optical properties of immune-conjugated gold nanorods (GNRs). We show, on a colon cancer model implanted in a chick chorioallantoic membrane (CAM), that this detection method enables conclusive differentiation between cancerous and normal tissues, where neither the distance between the light source and the intestinal wall, nor the background signal, affects the monitored signal. This optical method, which can easily be integrated in CE, is expected to reduce false positive and false negative results and improve identification of tumors and micro metastases.
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Affiliation(s)
- Rinat Ankri
- Bar-Ilan University, Faculty of Engineering & Institute of Nanotechnology & Advanced Materials, Ramat Gan 52900, Israel.
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Abstract
Video capsule endoscopy has revolutionized our ability to visualize the entire small bowel mucosa. This modality is established as a valuable tool for the diagnosis of obscure gastrointestinal bleeding, Crohn's disease, small bowel tumors, and other conditions involving the small bowel mucosa. This review includes an overview of the current and potential future clinical applications of small bowel video endoscopy.
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Affiliation(s)
- Uri Kopylov
- Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
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Abstract
Video capsule endoscopy has revolutionized our ability to visualize the entire small bowel mucosa. This modality is established as a valuable tool for the diagnosis of obscure gastrointestinal bleeding, Crohn’s disease, small bowel tumors, and other conditions involving the small bowel mucosa. This review includes an overview of the current and potential future clinical applications of small bowel video endoscopy.
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Affiliation(s)
- Uri Kopylov
- Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
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Hosoe N, Matsuoka K, Naganuma M, Ida Y, Ishibashi Y, Kimura K, Yoneno K, Usui S, Kashiwagi K, Hisamatsu T, Inoue N, Kanai T, Imaeda H, Ogata H, Hibi T. Applicability of second-generation colon capsule endoscope to ulcerative colitis: a clinical feasibility study. J Gastroenterol Hepatol 2013; 28:1174-1179. [PMID: 23517279 DOI: 10.1111/jgh.12203] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Colon capsule endoscopy has already been used for colon visualization and detection of polyps but its applicability to inflammatory bowel disease is still unconfirmed. The aim of this study was to assess the feasibility of evaluating the severity of mucosal inflammation in patients with ulcerative colitis (UC) using a second-generation colon capsule endoscope (CCE-2). METHODS Forty patients with histological confirmed diagnosis of UC were enrolled. Low-volume (2 L) polyethylene glycol solution with prokinetics (mosapride citrate and metoclopramide) regimen was used for the bowel preparation. In Phase 1, consisting of 10 patients, to confirm appropriate CCE-2 bowel preparation for UC. In Phase 2, consisting of 30 patients, CCE-2 was performed with a fixed bowel preparation regimen. CCE-2 findings were recorded for 8 h starting from capsule ingestion and conventional colonoscopy was subsequently performed on the same day. CCE-2 procedure completion rate and the colon cleansing level with a 4-point grading scale (poor, fair, good, and excellent) were evaluated in Phase 2. Correlations between Matts endoscopic scores as judged by CCE-2 and conventional colonoscopy were calculated. RESULTS CCE-2 procedure was completed within 8 h in 69% of the patients. The proportion of patients with good or excellent cleansing level was below 50%. However, Matts endoscopic scores determined by CCE-2 showed a strong correlation with scores obtained by conventional colonoscopy (average ρ = 0.797). CONCLUSIONS Although modifications in bowel preparation are needed, CCE-2 might be feasible for assessing the severity of mucosal inflammation in patients with UC.
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Affiliation(s)
- Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan.
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