Evaluation of a new pan-enteric video capsule endoscopy system in patients with suspected or established inflammatory bowel disease – feasibility study

Abstract

Background and study aims Inflammatory bowel disease (IBD) affects the small bowel and colon. Endoscopic evaluation of these organs is essential. The new pan-enteric Crohn’s capsule (PCC) system is customized for complete coverage of IBD lesions in the entire bowel, allowing assessment and follow-up of disease severity and extent. The aim of this study was to evaluate the functionality of the PCC system in patients with suspected or established IBD.

Patients and methods This was a prospective five-center feasibility study assessing the performance of PCC. Subjects ingested PCC after patency assurance with standard bowel preparation plus boosts. The primary endpoint was successful procedure, that is, video creation and report generation in accordance with methodology. Secondary endpoints were subjective coverage of the entire bowel, duration of reading time, video quality and occurrence of adverse events.

Results Forty-one patients were included in the study with a mean age of 40.8 years ± 15.5, 46 % of whom were males. Seventy-one percent of patients had established Crohn’s disease (CD) and 53 % had active disease. Cleansing was graded good/excellent in 95 %. All 41 videos met the primary endpoint. There was no retention, 83 % reached the toilet while still recording. Thirty-one percent of patients with CD had proximal disease. Bowel coverage was graded 6.7 ± 0.6 and 6.1 ± 1.3 (1 – 7, unconfident – confident), image quality 6.1 ± 0.8 (1 – 7, poor – excellent), and reading time 3.7 ± 1.4 (1 – 7, very short to very long).

Conclusions The PCC system is a minimally invasive system allowing extensive evaluation of the entire bowel in patients with IBD.

• References

• 1 Lichtenstein GR, Hanauer SB, Sandborn WJ. et al. Management of Crohnʼs disease in adults. Am J Gastroenterol 2009; 104: 465-483 ; quiz 464, 484
• 2 Wilkins T, Jarvis K, Patel J. Diagnosis and management of Crohnʼs disease. Am Fam Physician 2011; 84: 1365-1375
• 3 Arguelles-Arias F, Rodriguez-Oballe J, Duarte-Chang C. et al. Capsule endoscopy in the small bowel Crohnʼs disease. Gastroenterol Res Pract 2014; 2014: 529136
• 4 Park SK, Yang SK, Park SH. et al. Long-term prognosis of the jejunal involvement of Crohnʼs disease. J Clin Gastroenterol 2013; 47: 400-408
• 5 Flamant M, Trang C, Maillard O. et al. The prevalence and outcome of jejunal lesions visualized by small bowel capsule endoscopy in Crohnʼs disease. Inflamm Bowel Dis 2013; 19: 1390-1396
• 6 Cotter J, Dias de Castro F, Moreira MJ. et al. Tailoring Crohnʼs disease treatment: the impact of small bowel capsule endoscopy. J Crohns Colitis 2014; 8: 1610-1615
• 7 Leighton JA, Helper DJ, Gralnek IM. et al. Comparing diagnostic yield of a novel pan-enteric video capsule endoscope with ileocolonoscopy in patients with active Crohnʼs disease: a feasibility study. Gastrointest Endosc 2017; 85: 196-205.e191
• 8 Kopylov U, Yablecovitch D, Lahat A. et al. Detection of small bowel mucosal healing and deep remission in patients with known small bowel Crohnʼs disease using biomarkers, capsule endoscopy, and imaging. Am J Gastroenterol 2015; 110: 1316-1323
• 9 Peyrin-Biroulet L, Sandborn W, Sands BE. et al. Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol 2015; 110: 1324-1338
• 10 Hausmann J, Schmelz R, Walldorf J. et al. Pan-intestinal capsule endoscopy in patients with postoperative Crohnʼs disease: a pilot study. Scand J Gastroenterol 2017; 52: 1-6
• 11 Hale MF, Drew K, Ejenavi E. et al. PWE-029 Colon capsule endoscopy: a useful diagnostic modality that informs patient management. BMJ Gut 2015; 64: A223-A224
• 12 Hall B, Holleran G, McNamara D. PillCam COLON 2((c)) as a pan-enteroscopic test in Crohnʼs disease. World J Gastrointest Endosc 2015; 7: 1230-1232
• 13 Boal Carvalho P, Rosa B, Dias de Castro F. et al. PillCam COLON 2 in Crohnʼs disease: A new concept of pan-enteric mucosal healing assessment. World J Gastroenterol 2015; 21: 7233-7241
• 14 DʼHaens G, Lowenberg M, Samaan MA. et al. Safety and feasibility of using the second-generation Pillcam colon capsule to assess active colonic Crohnʼs disease. Clin Gastroenterol Hepatol 2015; 13: 1480-1486 e1483
• 15 Sung J, Ho KY, Chiu HM. et al. The use of Pillcam colon capsule in assessing mucosal inflammation in ulcerative colitis: a multicenter study. Endoscopy 2012; 44: 754-758
• 16 Oliva S, Cucchiara S, Civitelli F. et al. Colon capsule endoscopy compared with other modalities in the evaluation of pediatric Crohnʼs disease of the small bowel and colon. Gastrointest Endosc 2016; 83: 975-983
• 17 Song HJ, Moon JS, Jeon SR. et al. Diagnostic Yield and clinical impact of video capsule endoscopy in patients with chronic diarrhea: a Korean multicenter CAPENTRY study. Gut Liver 2017; 11: 253-260