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versão impressa ISSN 1130-0108
Rev. esp. enferm. dig. vol.103 no.7 Madrid jul. 2011
LETTERS TO THE EDITOR
Avoiding incomplete conventional colonoscopies: PillCam™ COLON capsule endoscopy
Evitando colonoscopias incompletas: colonocoscopia con cápsula endoscópica
Key words: Capsule endoscopy. Colonoscopy. Diverticular disease.
Palabras clave: Cápsula endoscópica. Colonoscopia. Diverticulosis.
Conventional colonoscopy is currently the preferred method to examine the colon. However, in some cases, cecal intubation is not possible due to technical problems. In fact, incomplete colonoscopy occurs from 5% to 25% in reported series (1-4). In these cases, to date, barium enema or CT-colonography were usually recommended to complete the colon examination. Whether emerging techniques, such as colon capsule endoscopy, could be useful in these situations has not been widely studied.
A 75-year-old woman with personal history of several abdominal surgeries (cholecystectomy, hysterectomy and eventroplasty) and colonic polyps was referred to our hospital because of recent changes in her bowel habit. Colonic examination revealed a diverticular short-angled segment in the sigmoid colon which made the progression of the endoscope impossible (Fig. 1). No other lesions were found. Therefore, we decided to perform a colon capsule endoscopy which showed a stenotic and poorly distended left colon with a mild diverticular disease (Figs. 2 and 3). No polyps were found. In spite of all these handicaps the procedure was complete and the colon capsule was naturally excreted before batteries expiration (< 10 h).
The capsule endoscopy has been demonstrated to be an accurate, painless and safe procedure for the patient. In fact, more than 1,000,000 procedures have been performed worldwide. Recently, new prototypes of capsule endoscopy, such as the PillCam™ ESO and the PillCam™ COLON, have been developed (5,6). Therefore, the examination areas are currently not limited only to the small bowel. As demonstrated by a recent meta-analysis including 7 studies that provided data on 626 patients, the colon capsule endoscopy is a valuable tool for the visualization of the colon (7). In fact, its sensitivity and specificity for polyps of any size and significant findings was 73% and 69%, and 89% and 86%, respectively (7). Moreover, a study published in 2009 by Van Gossum et al. (8), showed that the colon capsule endoscopy is complete, which means natural excretion, in more than 90% of the cases. The PillCam™ COLON capsule measures 11 X 31 mm, takes images from both ends and offers a battery-life that lasts 9-10 hours on average. These characteristics give the endoscopist the possibility to use the colon capsule in different scenarios rather than colorectal screening. Although, to date, there are not enough studies that strongly support this affirmation, the capsule colonoscopy should be taken into account after an incomplete colonoscopy.
Ignacio Fernández-Urién, Miriam Ostiz and Javier Jiménez
Department of Digestive Diseases. Hospital de Navarra. Pamplona, Navarra. Spain
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