Applicability of Second-generation Colon Capsule Endoscope to Ulcerative Colitis

A Clinical Feasibility Study

Naoki Hosoe; Katsuyoshi Matsuoka; Makoto Naganuma; Yosuke Ida; Yuka Ishibashi; Kayoko Kimura; Kazuaki Yoneno; Shingo Usui; Kazuhiro Kashiwagi; Tadakazu Hisamatsu; Nagamu Inoue; Takanori Kanai; Hiroyuki Imaeda; Haruhiko Ogata; Toshifumi Hibi

Disclosures

J Gastroenterol Hepatol. 2013;28(7):1174-1179. 

In This Article

Abstract and Introduction

Abstract

Background and Aim Colon capsule endoscopy has already been used for colon visualization and detection of polyps but its applicability to inflammatory bowel disease is still unconfirmed. The aim of this study was to assess the feasibility of evaluating the severity of mucosal inflammation in patients with ulcerative colitis (UC) using a second-generation colon capsule endoscope (CCE-2).

Methods Forty patients with histological confirmed diagnosis of UC were enrolled. Low-volume (2 L) polyethylene glycol solution with prokinetics (mosapride citrate and metoclopramide) regimen was used for the bowel preparation. In Phase 1, consisting of 10 patients, to confirm appropriate CCE-2 bowel preparation for UC. In Phase 2, consisting of 30 patients, CCE-2 was performed with a fixed bowel preparation regimen. CCE-2 findings were recorded for 8 h starting from capsule ingestion and conventional colonoscopy was subsequently performed on the same day. CCE-2 procedure completion rate and the colon cleansing level with a 4-point grading scale (poor, fair, good, and excellent) were evaluated in Phase 2. Correlations between Matts endoscopic scores as judged by CCE-2 and conventional colonoscopy were calculated.

Results CCE-2 procedure was completed within 8 h in 69% of the patients. The proportion of patients with good or excellent cleansing level was below 50%. However, Matts endoscopic scores determined by CCE-2 showed a strong correlation with scores obtained by conventional colonoscopy (average ρ = 0.797).

Conclusions Although modifications in bowel preparation are needed, CCE-2 might be feasible for assessing the severity of mucosal inflammation in patients with UC.

Introduction

The incidence and prevalence of ulcerative colitis (UC) remain high in Western countries.[1] In Asia, the numbers of UC patients have been increasing in recent years.[2] Mucosal inflammation in UC extends from the rectum to the proximal colon. In the therapeutic management of UC, colonoscopy plays a pivotal role in evaluating the severity and the extension of mucosal inflammation.[3,4]

Colon capsule endoscopy (CCE) was first reported in 2006.[5] CCE has been applied mainly for colorectal cancer screening.[5–13] Van Gossum et al.[11] reported that the first-generation CCE has only moderate sensitivity and specificity as compared with colonoscopy for surveillance of colorectal neoplasia. To overcome this inferiority to colonoscopy, second-generation CCE (CCE-2) was developed.[14] The CCE-2 device is equipped with a high frame rate camera which can obtain 4 to 35 images per second when the capsule is accelerated by peristalsis. Spada et al. reported that CCE-2 has a high sensitivity for the detection of clinically relevant polypoid lesions. A CCE procedure requires extensive, multi-step preparation[9] for colon cleansing and the capsule booster.

There are several benefits of CCE for patients with UC. In assessing mucosal inflammation in UC, CCE is considered to be appropriate because the procedure is relatively non-invasive and therefore has a level of high patient acceptance. UC patients do not need anesthesia when CCE is performed. However, the applicability of CCE for UC remains unconfirmed. A recent report on a study evaluating the feasibility of first-generation CCE for assessment of mucosal inflammation in UC[15] suggested that CCE cannot be recommended as a replacement for colonoscopy.

The aim of this study was to assess the feasibility of evaluating the severity of mucosal inflammation in UC patients using a CCE-2 with a reduced volume preparation regimen.

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