Z Gastroenterol 2011; 49 - A4
DOI: 10.1055/s-0031-1278435

Quantitative evaluation of a modified colonic preparation method as a less invasive and more effective procedure for colon capsule endoscopy

G Balogh 2, I Hritz 1, A Gaál 1, L Madácsy 1
  • 11st Department of Internal Medicine, Fejér Megyei Szent György Hospital, Székesfehérvár, Hungary
  • 2Department of Surgery, Kaposi Mór Teaching Hospital, Kaposvár, Hungary

Introduction: Colon capsule endoscopy (CCE) has received a widespread attention as a possible screening method for colorectal polyps and cancer. However, the performance and diagnostic accuracy of CCE is highly dependent on the colonic cleanliness. Regarding the conventional two days bowel preparation methods for CCE, a large amount of intake of fluids and 6 liters of polyethylene glycol was necessary to achieve adequate colonic visualization. The aims of our prospective study were to quantitatively compare the colonic cleanliness with three different modified colonic preparation protocols, and to assess the diagnostic yield and the positive predictive value (PPV) of CCE as compared to standard colonoscopy.

Patients and methods: We performed a single center prospective study on 43 pts with PillCam Colon capsule endoscopy. The quantitative assessment of colonic cleanliness was carried out with the evaluation of the histogram of the color bar (CB). Dominance of the green color was assessed with green color proportion value (GCPV) and indicated poor colonic cleanliness. Three different preparation protocols were compared: 4 liters (2+2) of PEG the day before of the procedure (PPA), 1 fleet phosphosoda on two days before and 3 liters of PEG the day before the procedure (PPB), and finally PPB plus 1 liter of PEG during the procedure (PPC) after the pyloric passage of the capsule.

Results: CCE detected single or multiple polyps in 12 out of 43 patients. Follow-up colonoscopy was positive in 10 out of these 12 patients, demonstrating a diagnostic yield of 28% and PPV of 83%. We observed a significantly accelerated small bowel transit time (P=0.049) and increased overall quantitative colonic cleanliness (P=0.034) in patients with PPC as compared to the PPA and PPB.

Conclusions: Color histogram analysis seems to be feasible to measure the colonic cleanliness quantitatively. Booster dose of 1 liter of PEG during the CCE study has a superior impact to the colonic cleanliness and may result a higher diagnostic yield for CCE.