LETTERS TO THE EDITOR

 

Avoiding incomplete conventional colonoscopies: PillCam™ COLON capsule endoscopy

Evitando colonoscopias incompletas: colonocoscopia con cápsula endoscópica

 

 

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Key words: Capsule endoscopy. Colonoscopy. Diverticular disease.

Palabras clave: Cápsula endoscópica. Colonoscopia. Diverticulosis.

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Dear Editor,

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.

 

Case report

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).

 

 

Discussion

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

 

References

1. Anderson ML, Heigh RI, McCoy GA, et al. Accuracy of assessment of the extent of examination by experienced colonoscopists. Gastrointest Endosc 1992;38:560-3.         [ Links ]

2. Marshall JB, Barthel JS. The frequency of total colonoscopy and terminal ileal intubation in the 1990s. Gastrointest Endosc 1993;39:518-20.         [ Links ]

3. Dafnis G, Blomqvist P, Pahlman L, et al. The introduction and development of colonoscopy within a defined population in Sweden. Scand J Gastroenterol 2000;35:765-71.         [ Links ]

4. Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 1997;112:594-642.         [ Links ]

5. Fernandez-Urien I, Carretero C, Armendáriz R, Muñoz-Navas M. Esophageal Capsule Endoscopy. World J Gastroenterol 2008:14; 5254-60.         [ Links ]

6. Fernández-Urién I, Carretero C, Borda A, Muñoz-Navas M. Colon Capsule Endoscopy. World J Gastroenterol 2008;14:5265-8.         [ Links ]

7. Rokkas T, Papaxoinis K, Triantafyllou K, Ladas SD. A meta-analysis evaluating the accuracy of colon capsule endoscopy in detecting colon polyps. Gastrointest Endosc 2010;71:792-8.         [ Links ]

8. Van Gossum A, Munoz-Navas M, Fernandez-Urien I, Carretero C, Gay G, Delvaux M, et al. PillCam™ colon capsule endoscopy compared to colonoscopy in detection of colon polyps and cancers. N Eng J Med 2009;361:264-70.         [ Links ]