Controlled colonic insufflation by a remotely triggered capsule for improved mucosal visualization

Background and study aims: Capsule endoscopy is an attractive alternative to colorectal cancer screening by conventional colonoscopy, but is currently limited by compromised mucosal visibility because of the lack of safe, controlled colonic insufflation. We have therefore developed a novel system of untethered, wireless-controlled carbon dioxide (CO₂) insufflation for use in colonic capsule endoscopy, which this study aims to assess in vivo.

Material and methods: This observational, nonsurvival, in vivo study used five Yorkshire-Landrace cross swine. A novel insufflation capsule was placed in the porcine colons, and we recorded volume of insufflation, time, force, visualization, and a pathologic assessment of the colon.

Results: The mean (standard deviation [SD]) diameter of insufflation was 32.1 (3.9) mm. The volume of CO₂ produced successfully allowed complete endoscopic visualization of the mucosa and safe proximal passage of the endoscope. Pathologic examination demonstrated no evidence of trauma caused by the capsule.

Conclusions: These results demonstrate the feasibility of a novel method of controlled colonic insufflation via an untethered capsule in vivo. This technological innovation addresses a critical need in colon capsule endoscopy.

• References

• 1 U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2009 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2013 Available at: www.cdc.gov/uscs Accessed: 21 March 2013
• 2 Selby JV, Friedman GD, Quesenberry CP et al. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 1992; 326: 653-657
• 3 Hardcastle JD, Chamberlain JO, Robinson MH et al. Randomised controlled trial of faecal-occult blood screening for colorectal cancer. Lancet 1996; 348: 1472-1477
• 4 Kronborg O, Fenger C, Olsen J et al. Randomised study of screening for colorectal cancer with faecal occult blood test. Lancet 1996; 348: 1467-1471
• 5 Winawer SJ, Fletcher RH, Miller L et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 1997; 112: 594-642
• 6 Bujanda L, Sarasqueta C, Zubiaurre L et al. Low adherence to colonoscopy in the screening of first-degree relatives of patients with colorectal cancer. Gut 2007; 56: 1714-1718
• 7 Fry LC, Vormbrock K, Olano C et al. Small-bowel endoscopy. Endoscopy 2011; 43: 978-84
• 8 Spada C, Hassan C et al. Second-generation colon capsule endoscopy compared with colonoscopy. Gastrointest Endosc 2011; 74: 581-589
• 9 Van Gossum A, Ibrahim M. Video capsule endoscopy: what is the future?. Gastroenterol Clin North Am 2010; 39: 807-826
• 10 Spada C, Hassan C, Sturniolo GC et al. Literature review and recommendations for clinical application of colon capsule endoscopy. Dig Liver Dis 2011; 43: 251-258
• 11 East JE, Bassett P, Arebi N et al. Dynamic patient position changes during colonoscope withdrawal increase adenoma detection: a randomized, crossover trial. Gastrointest Endosc 2011; 73: 456-463
• 12 Dellon ES, Hawk JS, Grimm IS et al. The use of carbon dioxide for insufflation during GI endoscopy: a systematic review. Gastrointest Endosc 2009; 69: 843-849
• 13 Maple JT, Banerjee S, Barth BA et al. Methods of luminal distention for colonoscopy. Gastrointest Endosc 2013; 77: 519-525
• 14 Gorlewicz JL, Battaglia S, Smith BF et al. Wireless insufflation of the gastrointestinal tract. IEEE Trans Biomed Eng 2013; 60: 1225-1233
• 15 Obstein KL, Battaglia S, Smith BF et al. Novel approach for colonic insufflation via an untethered capsule (with video). Gastrointest Endosc 2013; 177: 516-517
• 16 US Food and Drug Administration (US FDA) Available at: http://www.accessdata.fda.gov/scripts/fcn/fcnNavigation.cfm?rpt=scogsListing
• 17 Moshkowitz M, Hirsch Y, Carmel I et al. A novel device for rapid cleaning of poorly prepared colons. Endoscopy 2010; 42: 834-836
• 18 Wagener S, Shanker KR, Turnock RR et al. Colonic transit time – what is normal?. J Pediatr Surg 2004; 39: 166-169 ; discussion 166–169