PWE-219 First reported experience of colon capsule endoscopy (CCE) in routine clinical practice
Authors: V Sathyanarayana, K Drew, S Hardcastle, A J Lobo, D Majumdar, R Sidhu, M E McAlindon
Journal: Gut (2012)

<h3>Introduction</h3> The advantages of colon capsule endoscopy (CCE) over other imaging modalities include the absence of intubation, sedation or irradiation. Recent multicentre trials suggest a sensitivity of approaching 90% in detecting significant polyps<sup>1 2</sup> but there are no data regarding use in routine clinical practice. <h3>Methods</h3> Alternative modalities of colonic investigation were discussed with all patients requiring investigation. Data were collected prospectively on those undergoing colon capsule endoscopy following a standard bowel preparation. Small bowel patency was confirmed in patients with Crohn9s disease using the Agile patency system. <h3>Results</h3> 86 patients (67F; median age 42 (range 18–95)) underwent CCE (CC1, n=34; CC2, n=52). 81.4% had refused (n=43) or had had incomplete (n=27) colonoscopy. Indications: symptoms without alarm features (n=31), symptoms with alarm features (weight loss, bleeding, condition associated with malignancy; n=14), Crohn9s disease (n=17), symptoms with abnormal blood test results; n=15), anaemia (n=6), miscellaneous (n=3). CCE was complete in 79.5% (n=66), incomplete in 19.8% (n=17), 3.5% failed (one patient did not swallow the capsule; two provided no images). Median (range) time in the small and large bowel were 63.5 (0–424) and 121 (0–1020) min respectively and bowel cleanliness score 2 (1–4: excellent-poor). Findings were normal (31.4%), inflammatory bowel disease (IBD 25.6%: Crohn9s disease, n=13; ulcerative proctitis, n=1; NSAID colopathy, n=1; inflammation of uncertain significance, n=7), polyps (22.1%), diverticulosis (12.8%), angioectasia (5.8%), miscellaneous (3.5%), no images (3.5%). These were considered relevant to the indications in 25.6% (n=22, 15 of which were IBD). Outcomes included discharge (47.7%) and management change based on the findings (37.2%, including commencing (16.3%) or cessation (2.3%) of IBD therapy, further investigation (14.0%), advice regarding polyp surveillance (3.5%) and other treatment (2.3%). Half of the 20 patients with incomplete or failed studies were offered further investigations, six studies were considered sufficient to exclude organic disease, three showed active Crohn9s disease and one patient was too ill for further investigation. There were no complications. <h3>Conclusion</h3> CCE is an alternative for patients who refuse or have incomplete colonoscopy and which provides both small and large bowel visualisation. Although one in five studies were incomplete, sufficient information was provided to enable discharge in almost half the patients with functional bowel disorders and the identification of IBD in one quarter. <h3>Competing interests</h3> None declared. <h3>References</h3> 1. <b>Eliakim R</b>, Yassin K, Niv Y, <i>et al.</i> Prospective multicenter performance evaluation of the second-generation colon capsule compared with colonoscopy. <i>Endoscopy</i> 2009;<b>41</b>:1026–31. 2. <b>Spada C</b>, Hassan C, Munoz-Navas M, <i>et al.</i> Second-generation colon capsule endoscopy compared with colonoscopy. <i>Gastrointest Endosc</i> 2011;<b>74</b>:581–9.