Endoscopy 2006; 38(10): 963-970
DOI: 10.1055/s-2006-944832
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Evaluation of the PillCam Colon capsule in the detection of colonic pathology: results of the first multicenter, prospective, comparative study

R.  Eliakim1 , Z.  Fireman2 , I.  M.  Gralnek1 , K.  Yassin1 , M.  Waterman1 , Y.  Kopelman2 , J.  Lachter1 , B.  Koslowsky3 , S.  N.  Adler3
  • 1Rappaport Faculty of Medicine, Technion Israel Institute of Technology and Departments of Medicine and Gastroenterology, Rambam Medical Center, Haifa, Israel
  • 2Hillel-Yaffe Medical Center, Hadera, Israel
  • 3Bikur Cholim Hospital, Jerusalem, Israel
Further Information

Publication History

Submitted 24 August 2006

Accepted after revision 4 September 2006

Publication Date:
20 October 2006 (online)

Background and study aims: Population-based screening for colorectal cancer is widely recommended, with conventional colonoscopy considered to be the preferred diagnostic modality. However, compliance with screening colonoscopy is low and manpower capacity is limited. Capsule endoscopy might therefore represent a desirable alternative strategy.
Patients and methods: The PillCam Colon capsule endoscope was prospectively tested in a multicenter setting. The indications for endoscopy in the enrolled patients included colorectal cancer screening (43 %), postpolypectomy surveillance (26 %), and lower gastrointestinal signs and symptoms (31 %). Study subjects underwent colon preparation and then ingested the capsule on the morning of the examination, with conventional colonoscopy being performed the same day. The PillCam Colon capsule findings were reviewed by three experts in capsule endoscopy who were blinded to the conventional colonoscopy findings.
Results: A total of 91 subjects were enrolled in three Israeli centers (55 men, 36 women; mean age 57), and the results were evaluable in 84 cases. The capsule was excreted within 10 hours in 74 % of the patients and reached the rectosigmoid colon in the other 16 %. Of the 84 evaluable patients, 20 (24 %) had significant findings, defined as at least one polyp of 6 mm or more in size or three or more polyps of any size: 14/20 (70 %) were identified with the capsule and 16/20 (80 %) were identified by conventional colonoscopy. Polyps of any size were found in 45 patients, 34/45 (76 %) found by the capsule and 36/45 (80 %) by conventional colonoscopy. In comparison with conventional colonoscopy, false-positive findings on PillCam Colon capsule examination were recorded in 15/45 cases (33 %). There were no adverse events related to the capsule endoscopy.
Conclusions: PillCam Colon capsule endoscopy appears to be a promising new modality for colonic evaluation. Further improvements in the procedure will probably increase capsule examination completion and polyp detection rates. Additional studies are needed to evaluate the accuracy of PillCam Colon endoscopy in other patient populations with different prevalence levels of colonic disease.

References

  • 1 Burnand B, Harris J K, Wietlisbach V. et al . Use, appropriateness, and diagnostic yield of screening colonoscopy: an international observational study (EPAGE).  Gastrointest Endosc. 2006;  63 1018-1026
  • 2 Rex D K, Johnson D A, Lieberman D A. et al . Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology.  Am J Gastroenterol. 2000;  95 868-877
  • 3 Smith R A, von Eschenbach A C, Wender R. et al . American Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancers.  CA Cancer J Clin. 2001;  51 38-75
  • 4 US Preventive Services Task Force . Screening for colorectal cancer: recommendation and rationale.  Ann Intern Med. 2002;  137 129-131
  • 5 Winawer S, Fletcher R, Rex D. et al . Colorectal cancer screening and surveillance: clinical guidelines and rationale - update based on new evidence.  Gastroenterology. 2003;  124 544-560
  • 6 Cotton P B, Durkalski V L, Pineau B C. et al . Computed tomographic colonography (virtual colonoscopy): a multi-center comparison with standard colonoscopy for detection of colorectal neoplasia.  JAMA. 2004;  291 1713-1719
  • 7 Nadel M R, Blackman D K, Shapiro J A, Seeff L C. Are people being screened for colorectal cancer as recommended? Results from the National Health Interview Survey.  Prev Med. 2002;  35 199-206
  • 8 Harewood G C, Wiersema M J, Melton L J. A prospective, controlled assessment of factors influencing acceptance of screening colonoscopy.  Am J Gastroenterol. 2002;  97 3186-3194
  • 9 Janz N K, Wren P A, Schottenfeld D, Guire K E. Colorectal cancer screening attitudes and behavior: a population-based study.  Prev Med. 2003;  37 627-634
  • 10 Rex D K, Cutler C S, Lemmel G T. et al . Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies.  Gastroenterology. 1997;  112 24-28
  • 11 van Rijn J C, Reitsma J B, Stoker J. et al . Polyp miss rate determined by tandem colonoscopy: a systematic review.  Am J Gastroenterol. 2006;  101 343-350
  • 12 Bensen S, Mott L A, Dain B. et al . The colonoscopic miss rate and true one-year recurrence of colorectal neoplastic polyps. Polyp Prevention Study Group.  Am J Gastroenterol. 1999;  94 194-199
  • 13 Pickhardt P J, Nugent P A, Mysliwiec P A. et al . Location of adenomas missed by optical colonoscopy.  Ann Intern Med. 2004;  141 352-359
  • 14 Gralnek I M, Rabinovitz R, Afik D, Eliakim R. A simplified ingestion procedure for esophageal capsule endoscopy: initial evaluation in healthy volunteers.  Endoscopy. 2006;  38 917-922
  • 15 Rex D K, Rahmani E Y, Haseman J H. et al . Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice.  Gastroenterology. 1997;  112 17-23
  • 16 Pickhardt P J, Choi J R, Hwang I. et al . Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults.  N Engl J Med. 2003;  349 2191-2200
  • 17 Pineau B C, Paskett E D, Chen G J. et al . Virtual colonoscopy using oral contrast compared with colonoscopy for the detection of patients with colorectal polyps.  Gastroenterology. 2003;  125 304-310

R. Eliakim, M. D.

Department of Gastroenterology · Rambam Medical Center · Haifa 31 096 · Israel ·

Fax: +972-4-854-3058

Email: r_eliakim@rambam.health.gov.il