Is there a role for colon capsule endoscopy in acute disease?

Benjamin Abbadessa, I. Michael Leitman

Department of Surgery, Albert Einstein College of Medicine, Beth Israel Medical Center, New York, USA.

DOI: 10.4236/ojgas.2012.24031                

Abstract

Colon capsule endoscopy (CCE) was first put into clinical practice for the evaluation of the small bowel in patients presenting with a gastrointestinal bleed unsuccessfully diagnosed by upper GI endoscopy and colonoscopy. With the recent advent of new technology, there is improved visualization of the intestinal mucosa and subsequently a higher sensitivity for identification of mural pathology, as seen in many recent prospective studies. CCE has now been studied both in the US and in Europe as a modality for colon cancer screening as well as for the diagnosis of inflammatory bowel disease. When compared to conventional colonoscopy, CCE has been shown to have a sensitivity of greater than 88% for identifying 6mm colonic polyps and over 90% for 1 cm polyps. Therefore its use as a screening tool for colon cancer must be evaluated. In patients suspected to have colitis secondary to inflammatory bowel disease (IBD), it has been shown to have 89% sensitivity for identifying active colonic inflammation. For higher risk patients that requiring urgent colonoscopy, CCE offers an attractive alternative with the potential for a reduced risk on iatrogenic injury. Colon capsule endoscopy may also play an important role in the diagnosis and surveillance of IBD with colonic manifestations. Colonoscopy during active severe disease is associated with an increased risk of perforation due to mucosal inflammation and friability, allowing us to consider CCE as a potentially safer alternative. CCE appears to be most useful for patients with acute lower GI bleeding, inflammatory bowel disease, colonic ischemia or other mucosal-based lesions.

Keywords

Colitis; Carcinoma Colon; Polyp; Lower Gastrointestinal Hemorrhage; Capsule Endoscopy; Colonoscopy; Ulcerative Colitis; Regional Enteritis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Bandorski, D., Lotterer, E., Hartmann, D., Jakobs, R., Brück, M., Hoeltgen, R., Wieczorek, M., Brock, A., de Rossi, T. and Keuchel, M. (2011) Capsule endoscopy in patients with cardiac pacemakers and implantable cardioverter-defibrillators—A retrospective multicenter investigation. Journal of Gastrointestinal and Liver Disease, 20, 33-37.
[2]	De Palma, G.D., Masone, S., Persico, M., Siciliano, S., Salvatori, F., Maione, F., Esposito, D. and Persico, G. (2012) Capsule impaction presenting as acute small bowel perforation: A cases series. Journal of Medical Case Reports, 6, 121. doi:10.1186/1752-1947-6-121
[3]	Kakugawa, Y., Saito, Y. and Saito, S. (2012) New reduced volume preparation regimen in colon capsule endoscopy. World Journal of Gastroenterology, 18, 2092- 2098. doi:10.3748/wjg.v18.i17.2092
[4]	Lohsiriwat, V., Sujarittanakarn, S., Akaraviputh, T., Ler-takyamanee, N., Lohsiriwat, D. and Kachinthorn, U. (2009) What are the risk factors of colonoscopic perforation? BMC Gastroenterology, 9, 71. doi:10.1186/1471-230X-9-71
[5]	Arora, G., Mannalithara, A., Singh, G., Gerson, L.B. and Triadafilopoulos, G. (2009) Risk of perforation from a colonoscopy in adults: A large population-based study. Gastrointestinal Endoscopy, 69, 654-664. doi:10.1016/j.gie.2008.09.008
[6]	Anderson, M.L., Pasha, T.M. and Leighton, J.A. (2000) Endoscopic perforation of the colon: Lessons from a 10-year study. American Journal of Gastroenterology, 95, 3418-3422. doi:10.1111/j.1572-0241.2000.03356.x
[7]	Lalor, P.F. and Mann, B.D. (2007) Splenic rupture after colonoscopy. Journal of the Society of Laparoendoscopic Surgeons, 11, 151-156.
[8]	Ghevariya, V., Kevorkian, N., Asarian, A., Anand, S. and Krishnaiah, M. (2011) Splenic injury from colonoscopy: A review and management guidelines. Southern Medical Journal, 104, 515-520. doi:10.1097/SMJ.0b013e31821e9283
[9]	Van Gossum, A., Munoz-Navas, M. and Fernandez-Urien, I. (2009) Capsule Endoscopy versus Colonoscopy for the Detection of Polyps and Cancer. The New England Journal of Medicine, 361, 264-270. doi:10.1056/NEJMoa0806347
[10]	Kolligs, F.T. (2012) Screening for colorectal cancer: Current evidence and novel developments. Radiologe, 52, 504-510. doi:10.1007/s00117-011-2281-0
[11]	Spada, C., De Vincentis, F. and Cesaro, P. (2012) Accuracy and safety of second-generation PillCam COLON capsule for colorectal polyp detection. Therapeutic Advances in Gastroenterology, 5, 173-178.
[12]	Eliakim, R., Yassin, K., Niv, Y., Metzger, Y., Lachter, J., Gal, E., et al. (2009) Prospective multicenter performance evaluation of the second-generation colon capsule compared with colonoscopy. Endoscopy, 41, 1026-1031. doi:10.1055/s-0029-1215360
[13]	Spada, C., Hassan, C., Munoz-Navas, M., Neuhaus, H., Deviere, J., Fockens, P. et al. (2011) Second-generation colon capsule endoscopy compared with colonoscopy. Gastrointestinal Endoscopy, 74, 581-589. doi:10.1016/j.gie.2011.03.1125
[14]	Herrerías-Gutiérrez, J.M., Argüelles-Arias, F., Caunedo- álvarez, A., San-Juan-Acosta, M., Romero-Vázquez, J., García-Montes, J.M. and Pellicer-Bautista, F. (2011) Pill-CamColon Capsule for the study of colonic pathology in clinical practice. Study of agreement with colonoscopy. Revista Espa?ola de Enfermedades Digestivas, 103, 69- 75. doi:10.4321/S1130-01082011000200004
[15]	Sung, J., Ho, K.Y., Chiu, H.M., Ching, J., Travis, S. and Peled, R. (2012) The use of Pillcam Colon in assessing mucosal inflammation in ulcerative colitis: A multicenter study. Endoscopy, 44, 754-758. doi:10.1055/s-0032-1309819
[16]	Cuschieri, J.R., Osman, M.N., Wong, R.C., Chak, A. and Isenberg, G.A. (2012) Small bowel capsule endoscopy in patients with cardiac pacemakers and implantable cardioverter defibrillators: Outcome analysis using telemetry review. World Journal of Gastrointestinal Endoscopy, 4, 87-93. doi:10.4253/wjge.v4.i3.87
[17]	Carretero, C., Fernandez-Urien, I. and Betes, M. (2008) Role of videocapsule endoscopy for gastrointestinal bleeding. World Journal of Gastrointestinal, 14, 5261-5264. doi:10.3748/wjg.14.5261
[18]	Lecleire, S., Iwanicki-Caron, I., Di-Fiore, A., Elie, C., Alhameedi, R., Ramirez, S., Hervé, S., Ben-Soussan, E., Ducrotté, P. and Antonietti, M. (2012) Yield and impact of emergency capsule enteroscopy in severe obscure-overt gastrointestinal bleeding. Endoscopy, 44, 337-342. doi:10.1055/s-0031-1291614
[19]	Park, J.J., Cheon, J.H., Kim, H.M. and Park, H. (2010) Negative capsule endoscopy without subsequent enteroscopy does not predict lower long-term rebleeding rates in patients with obscure GI bleeding. Gastrointestinal Endoscopy, 71, 990-997. doi:10.1016/j.gie.2009.12.009
[20]	Chen, X., Ran, Z.-H. and Tong, J.-L. (2007) A meta-analysis of the yield of capsule endoscopy compared to double-balloon enteroscopy in patients with small bowel diseases. World Journal of Gastroenterology, 13, 4372- 4378.
[21]	Strate, L.L. (2010) Editorial: Urgent colonoscopy in lower GI bleeding: Not so fast. American Journal of Gastroen-terology, 105, 2643-2645. doi:10.1038/ajg.2010.401
[22]	Calabrese, C., Liguori, G., Gionchetti, P., Rizzello, F., Laureti, S., Simone, M.P., Poggioli, G. and Campieri, M. (2011) Obscure gastrointestinal bleeding: Single centre experience of capsule endoscopy. Internal and Emergency Medicine, Epub ahead of print. doi:10.1007/s11739-011-0699-z
[23]	Navaneethan, U., Parasa, S., Venkatesh, P.G., Triku-danathan, G. and Shen, B. (2011) Prevalence and risk factors for colonic perforation during colonoscopy in hospitalizedinflammatory bowel disease patients. Journal of Crohn’s and Colitis, 5, 189-195. doi:10.1016/j.crohns.2010.12.005
[24]	Riccioni, M.E., Urgesi, R. and Cianci, R. (2012) Colon capsule endoscopy: Advantages, limitations and expectations. Which novelties? World Journal of Gastrointestinal Endoscopy, 4, 99-107.
[25]	Zhou, N., Chen, W.X., Chen, S.H., Xu, C.F. and Li, Y.M. (2011) Inflammatory bowel disease unclassified. Journal of Zhejiang University Science B, 12, 280-286. doi:10.1631/jzus.B1000172
[26]	Lopes, S., Figueiredo, P. and Portela, F. (2010) Capsule endoscopy in inflammatory bowel disease type unclassi-fied and indeterminate colitis serologically negative. Inflammatory Bowel Disease, 16, 1663-1668.
[27]	Parikh, D.A., Parikh, J.A. and Albers, G.C. (2009) Acute small bowel perforation after wireless capsule endoscopy in a patient with Crohn’s disease: A case report. Cases Journal, 2, 7607. doi:10.4076/1757-1626-2-7607
[28]	Rameshshanker, R. and Arebi, N. (2012) Endoscopy in inflammatory bowel disease when and why. World Journal of Gastrointestinal Endoscopy, 4, 201-211. doi:10.4253/wjge.v4.i6.201
[29]	Redondo-Cerezo, E. (2010) Role of wireless capsule endoscopy in inflammatory bowel disease. World Journal of Gastrointestinal Endoscopy, 2, 179-185.
[30]	Taddio, A., Simonini, G., Lionetti, P., Lepore, L., Marte-lossi, S., Ventura, A. and Cimaz, R. (2011) Usefulness of wireless capsule endoscopy for detecting inflammatory bowel disease in children presenting with arthropathy. European Journal of Pediatrics, 170, 1343-1347. doi:10.1007/s00431-011-1505-7
[31]	Katsinelos, P., Vasiliadis, T. and Soufleris, K. (2008) Capsule endoscopy findings in congenital afibrinogene-mia-associated angiopathy. VASA, 37, 383-385. doi:10.1024/0301-1526.37.4.383
[32]	Beaton, C., Davies, M. and Beynon, J. (2012) The management of primary small bowel and colon lymphoma— A review. International Journal of Colorectal Disease, 27, 555-563. doi:10.1007/s00384-011-1309-2
[33]	Rana, S.S., Bhasin, D.K. and Singh, K. (2011) Colonic lesions in patients undergoing small bowel capsule endoscopy. International Journal of Colorectal Disease, 26, 699-702. doi:10.1007/s00384-011-1167-y
[34]	Hatoum, O.A., Binion, D.G. and Phillips, S.A. (2005) Radiation induced small bowel “web” formation is associated with acquired microvascular dysfunction. Gut, 54, 1797-1800. doi:10.1136/gut.2005.073734