Introduction The Pillcam Colon is a novel wireless and non-invasive modality to visualise the colon. This study evaluates the utility of Pillcolon in routine clinical practice and impact on patient management.
Methods Patients were required to ingest laxatives according to the protocol. This consisted of 1.5-l Moviprep on the evening prior, 0.5-l on the morning of the procedure (09:00) followed by 20 mg domperidone (10:45) before swallowing the capsule (11:00). The patient had 45 ml Fleet phosphor-soda (DeWitt) at 13:00 and 30 ml (with 1 litre of water each time) at 17:00. A light snack was given at 18:00, followed by a bisacodyl suppository at 19:30 and patients were allowed home at 21:00. A 4-point grading scale was used to objectively describe the cleanliness of the colon (1=excellent, 2=good, 3=fair, 4=poor). Data were collected for all patients including demographics, indications, findings and subsequent change in management.
Results Twenty-four examinations were performed in 23 patients: 19 females, mean age 45 years (range 16–84). The indications for Pillcolon included assessment of known inflammatory bowel disease (IBD, n=3), polyp surveillance (n=2) and blue rubber naevus syndrome (n=1). In 17 patients, Pillcolon was used to investigate the presence of IBD due to symptoms of altered bowel habit/pain (n=7), symptoms and the presence of anaemia/acute phase response or abnormal radiology (n=9) or with a family history (n=1). Pillcolon was chosen as a modality due to patient refusal to undergo standard colonoscopy (n=9), incomplete colonoscopy (n=11), physician choice (n=3) and unfit for colonoscopy (n=1). The capsule spent median of 81 min (20–424 min) in the small bowel and median of 168 min (0–547 min) in the colon. Ileum was seen in all and complete colon examination was achieved in 13 (54%) patients. The median cleanliness score was 2.5 (1–4) with a median reading time of 27 min (13–52 min). Findings included polyps (4), diverticulosis (3), colonic Crohn's (3), small bowel Crohn's (1), NSAID colopathy (1) and angioectasia (1). As a result of Pillcolon, 3 patients were treated for Crohn's disease, 2 were referred for double balloon enteroscopy for histology and 3 patients were enrolled for polyp surveillance. Ten patients were discharged. NSAIDs was stopped in one patient and warfarin commenced in another (no contra-indication).
Conclusion Pillcolon is a useful modality to investigate the colon, with a positive impact on patient management, particularly in patients who refuse or have failed colonoscopy. However comparisons with other standard modalities and further optimisation of bowel preparation are required, prior to advocating its use in routine practice.
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