Introduction The PillCam Colon Capsule is a minimally invasive colonic imaging modality that is emerging as a safe and effective tool to visualise the colon. To date the majority of studies have focused on its use in research settings where it has been evaluated for colonic polyp and cancer detection.
Method The aim of this study is to report on the current clinical use of colon capsule in a large teaching hospital in the South of
England. This was a single centre retrospective review of all the PillCam colon capsules performed from April 2015 to
Results A total of 37 patients (27 females, 10 males), median age 43.5 (maximum age 82 years and minimum age 20 years) were evaluated. 22/37 (59.5%) had a previous attempt at colonoscopy. Reasons for colon capsule over colonoscopy were: 12/37 pain. 12/37 need for small bowel investigations, 4/37 anxiety, 2/37 patient choice, 2/37 reaction to IV contrast for CT, 1/37 learning difficulties, 1/37 Ehlers-Danlos, 1/37 tachycardia at flexible sigmoidoscopy and 1/37 agorophobia.
The colon capsule was completed in 23/37 (62%) of patients. In 4/14 cases the capsule did not exit the stomach, so a clinic appointment is scheduled to discuss positioning of the capsule with gastroscopy. In 10/14 patients the colon capsule was incomplete; 3 reached the left colon and 7 reached the rectum. In 2/14 incomplete colon capsules a flexible sigmoidoscopy completed investigations. 3/14 incomplete colon capsule patients were discharged as a functional disorder was diagnosed. 2/14 patients are awaiting colonoscopy under GA and 1/14 a flexible sigmoidoscopy for polyp removal. 1/14 had a colonoscopy and polypectomy under sedation. 1 patient subsequently died, but this was unrelated to the colon capsule. 87% of the cases avoided subsequent colonoscopy. There were no complications observed in the series.
16/23 (69.6%) completed colon capsules identified pathology. 7 had features of inflammatory bowel disease. 6 identified polyps; 2 proceeded to endoscopic resection and the remaining 4 diminutive polyps are scheduled a clinic appointment to discuss the relative merits of endoscopic resection. The remaining 3 colon capsules identified threadworms; diverticular disease and angioectasia respectively.
Conclusion Colon capsule is safe and colonoscopy was avoided in 87% of patients. It is associated with a high pick up rate for pathology. The failure rate is high but usually in the left colon where a flexible sigmoidoscopy can complete examination easily. We believe that it is an effective approach for investigation of patients where tolerance to colonoscopy is likely to be poor, or where additional small bowel investigation is required, particularly in the evaluation of IBD or obscure bleeding where radiological imaging may be less effective or contraindicated.
Disclosure of Interest None Declared
- colon capsule endoscopy
- Pill cam