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Rosa B, Andrade P, Lopes S, Gonçalves AR, Serrazina J, Marílio Cardoso P, Silva A, Macedo Silva V, Cotter J, Macedo G, Figueiredo PN, Chagas C. Pan-Enteric Capsule Endoscopy: Current Applications and Future Perspectives. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:89-100. [PMID: 38572440 PMCID: PMC10987171 DOI: 10.1159/000533960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/13/2023] [Indexed: 04/05/2024]
Abstract
Background The role of capsule endoscopy in the evaluation of the small bowel is well established, and current guidelines position it as a first-line test in a variety of clinical scenarios. The advent of double-headed capsules further enabled the endoscopic assessment of colonic mucosa and the opportunity for a one-step noninvasive examination of the entire bowel (pan-enteric capsule endoscopy [PCE]). Summary We reviewed the technical procedure and preparation of patients for PCE, as well as its current clinical applications and future perspectives. In non-stricturing and non-penetrating Crohn's disease affecting the small bowel and colon, PCE monitors disease activity by assessing mucosal healing, a major treatment outcome, with a higher diagnostic yield than cross-sectional imaging or conventional colonoscopy. Also in ulcerative colitis, double-headed capsules have been used to monitor disease activity noninvasively. Currently, validated scoring systems have been specifically devised for these double-headed capsules and permit a standardized assessment of the inflammatory burden. In suspected mid-lower digestive bleeding, some exploratory studies have demonstrated the feasibility and high diagnostic yield of PCE, which may work as a filter indicating which patients may benefit of further invasive procedures, namely, for planned hemostatic procedures. The possibility of using PCE is also discussed in the context of polyposis syndromes with simultaneous involvement of the small intestine and colon. Key Messages PCE is a feasible, effective, and safe diagnostic procedure to evaluate the small bowel and colon. It has been increasingly explored in the setting of inflammatory bowel diseases and, more recently, in suspected mid-lower digestive bleeding. PCE is expected to reduce the demand for invasive procedures and expand the scope of noninvasive intestinal evaluation in the coming future.
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Affiliation(s)
- Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Patrícia Andrade
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center Porto, Porto, Portugal
| | - Sandra Lopes
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Rita Gonçalves
- Gastroenterology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Juliana Serrazina
- Gastroenterology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Pedro Marílio Cardoso
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center Porto, Porto, Portugal
| | - Andrea Silva
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Vítor Macedo Silva
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center Porto, Porto, Portugal
| | - Pedro Narra Figueiredo
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Cristina Chagas
- Gastroenterology Department, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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Toskas A, Laskaratos FM, Coda S, Banerjee S, Epstein O. Is Panenteric Pillcam TM Crohn's Capsule Endoscopy Ready for Widespread Use? A Narrative Review. Diagnostics (Basel) 2023; 13:2032. [PMID: 37370927 DOI: 10.3390/diagnostics13122032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Patients diagnosed with Crohn's disease are increasingly subjected to repeat colonoscopic and radiological examinations to assess the extent of the disease severity and the effects of treatment. PillcamTM Crohn's video capsule, a modified colon capsule, was developed to generate a minimally invasive mouth to rectum video of the gastrointestinal tract. The capsule provides a wide-angle panoramic mucosal view to assess inflammation, ulceration, stenosis, disease extent, and effect of treatment. This review summarizes the evidence of its utility in both adult and paediatric Crohn's disease and reviews the scoring systems used to quantify findings. The literature survey indicates that the PillcamTM Crohn's capsule offers high sensitivity and specificity for the detection of inflammatory lesions and the extent and distribution of disease, and it could be considered a reliable imaging modality in both adults and childhood with Crohn's disease.
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Affiliation(s)
| | - Faidon-Marios Laskaratos
- Digestive Diseases Centre, Queen's Hospital, Barking Havering and Redbridge University Hospitals NHS Trust, Rom Valley Way, Romford RM7 0AG, UK
| | - Sergio Coda
- Digestive Diseases Centre, Queen's Hospital, Barking Havering and Redbridge University Hospitals NHS Trust, Rom Valley Way, Romford RM7 0AG, UK
| | - Saswata Banerjee
- Digestive Diseases Centre, Queen's Hospital, Barking Havering and Redbridge University Hospitals NHS Trust, Rom Valley Way, Romford RM7 0AG, UK
| | - Owen Epstein
- Royal Free Hospital, Pond St., London NW3 2QG, UK
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Tamilarasan AG, Tran Y, Paramsothy S, Leong R. The diagnostic yield of pan-enteric capsule endoscopy in inflammatory bowel disease: A systematic review and meta-analysis. J Gastroenterol Hepatol 2022; 37:2207-2216. [PMID: 36150392 PMCID: PMC10092087 DOI: 10.1111/jgh.16007] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/15/2022] [Accepted: 09/03/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Capsule endoscopy (CE) is a non-invasive diagnostic modality enabling real time video imaging of the gastrointestinal (GI) mucosa. Pan-enteric capsule endoscopy (PCE) is now able to thoroughly assess the entire GI tract, including for inflammatory bowel disease (IBD). Our aim was to evaluate the diagnostic accuracy of PCEs in IBD. METHODS We comprehensively searched electronic databases (MEDLINE, SCOPUS, EMBASE, and Cochrane Central Register of Controlled Trials) for studies comparing the diagnostic accuracy of PCE with endoscopic evaluation, intestinal ultrasound or magnetic resonance enterography (MRE). Data were analyzed by calculating forest plots and the use of the I2 statistic for heterogeneity. RESULTS Fourteen studies were identified, with seven studies evaluating PCE diagnostic yield in Crohn's disease (CD) and seven studies in ulcerative colitis (UC). In CD, there was a trend to superiority of PCE over MRE and colonoscopy with a pooled odds ratio (OR) of 1.25 (95% CI, 0.85-1.86%) for the detection of CD. This translates to an increased diagnostic yield of 5% and 7% for PCE compared with MRE and colonoscopy, respectively. PCEs had a diagnostic sensitivity for the detection of UC of 93.8% (95% CI, 87.6-97.0%) and a specificity of 69.8% (95% CI, 38.2-89.6%). CONCLUSION PCEs have a comparable diagnostic yield to colonoscopy and MRE in Crohn's disease. The major difficulty remains standardization of PCE scoring systems and the lack of transmural assessment. In UC, PCE has an excellent diagnostic sensitivity and positive predictive value, but there are limitations to its use including the lack of histologic assessment and poor specificity.
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Affiliation(s)
- Aravind Gokul Tamilarasan
- Faculty of Medicine and Health, Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Gastroenterology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Yvonne Tran
- Macquarie University, Macquarie Park, New South Wales, Australia
| | - Sudarshan Paramsothy
- Faculty of Medicine and Health, Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Gastroenterology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Department of Gastroenterology, Macquarie University Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Rupert Leong
- Faculty of Medicine and Health, Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Gastroenterology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Department of Gastroenterology, Macquarie University Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Capsule Endoscopy in Inflammatory Bowel Disease: When? To Whom? Diagnostics (Basel) 2021; 11:diagnostics11122240. [PMID: 34943477 PMCID: PMC8700081 DOI: 10.3390/diagnostics11122240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/24/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022] Open
Abstract
Capsule endoscopy (CE) has proven to be a valuable diagnostic modality for small bowel diseases over the past 20 years, particularly Crohn's disease (CD), which can affect the entire gastrointestinal tract from the mouth to the anus. CE is not only used for the diagnosis of patients with suspected small bowel CD, but can also be used to assess disease activity, treat-to-target, and postoperative recurrence in patients with established small bowel CD. As CE can detect even mildly non-specific small bowel lesions, a high diagnostic yield is not necessarily indicative of high diagnostic accuracy. Moreover, the cost effectiveness of CE as a third diagnostic test employed usually after ileocolonoscopy and MR or CT enterography is an important consideration. Recently, new developments in colon capsule endoscopy (CCE) have increased the utility of CE in patients with ulcerative colitis (UC) and pan-enteric CD. Although deflation of the colon during the examination and the inability to evaluate dysplasia-associated lesion or mass results in an inherent risk of overestimation or underestimation, the convenience of CCE examination and the risk of flare-up after colonoscopy suggest that CCE could be used more actively in patients with UC.
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Bruining DH, Oliva S, Fleisher MR, Fischer M, Fletcher JG. Panenteric capsule endoscopy versus ileocolonoscopy plus magnetic resonance enterography in Crohn's disease: a multicentre, prospective study. BMJ Open Gastroenterol 2021; 7:bmjgast-2019-000365. [PMID: 32499275 PMCID: PMC7282309 DOI: 10.1136/bmjgast-2019-000365] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Crohn's disease diagnosis and monitoring remains a great clinical challenge and often requires multiple testing modalities. Assessing Crohn's disease activity in the entire gastrointestinal (GI) tract using a panenteric capsule endoscopy (CE) system could be used as an alternative to colonoscopy and cross-sectional imaging. This study assessed the accuracy and safety of panenteric CE in Crohn's disease as compared with ileocolonoscopy (IC) and/or magnetic resonance enterography (MRE). METHODS A prospective, multicentre study was performed in subjects with established Crohn's disease. Individuals with proven small bowel patency underwent a standardised bowel preparation, followed by CE ingestion and IC either the same or following day. MRE, IC, and CE interpretations were performed by blinded central readers using validated scoring systems. The primary endpoint was the overall sensitivity of CE vs MRE and/or IC in Crohn's disease subjects. RESULTS Study enrolment included 158 subjects from 21 sites in the USA, Austria, and Israel. Of those, 99 were included in the analysis. Imaging modality scores indicated none to mild inflammation in the proximal small bowel and colon, but discrepant levels of inflammation in the terminal ileum. Overall sensitivity for active enteric inflammation (CE vs MRE and/or IC) was 94% vs 100% (p=0.125) and specificity was 74% vs 22% (p=0.001). Sensitivity of CE was superior to MRE for enteric inflammation in the proximal small bowel (97% vs 71%, p=0.021), and similar to MRE and/or IC in the terminal ileum and colon (p=0.500-0.625). There were seven serious adverse advents of which three were related to the CE device. CONCLUSION Panenteric CE is a reliable tool for assessing Crohn's disease mucosal activity and extent compared with more invasive methods. This study demonstrates high performance of the panenteric CE as compared to MRE and/or IC without the need for multiple tests in non-stricturing Crohn's disease. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT03241368.
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Affiliation(s)
- David Henry Bruining
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza, University of Rome, Rome, Italy
| | | | - Monika Fischer
- Department of Internal Medicine, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Ismail MS, Semenov S, Sihag S, Manoharan T, Douglas AR, Reill P, Kelly M, Boran G, O’Connor A, Breslin N, O’Donnell S, Ryan B, McNamara D. Colon capsule endoscopy is a viable alternative to colonoscopy for the investigation of intermediate- and low-risk patients with gastrointestinal symptoms: results of a pilot study. Endosc Int Open 2021; 9:E965-E970. [PMID: 34079884 PMCID: PMC8159609 DOI: 10.1055/a-1401-9528] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 02/11/2021] [Indexed: 12/15/2022] Open
Abstract
Background and study aims Colon capsule endoscopy (CCE) is a recommended viable alternative to colonoscopy for colonic visualisation in a variety of clinical settings with proven efficacy in polyp detection, surveillance, screening and Inflammatory Bowel Disease (IBD) assessment. CCE efficacy in an unselected average risk symptomatic cohort has yet to be established. The aim of this study was to determine the feasibility of CCE imaging assessment in average risk symptomatic patients as an alternative to colonoscopy with and without additional biomarker assessment. Patients and methods This was a prospective, single-center comparison study of colonoscopy, CCE and biomarker assessment. Results Of 77 invited subjects, 66 underwent both a CCE and colonoscopy. A fecal immunochemical test (FIT) and fecal calprotectin (FC) were available in 56 and 59 subjects. In all 64 % (n = 42) had any positive finding with 16 (24 %) found to have significant disease (high-risk adenomas, IBD) on colonoscopy. The CCE completion rate was 76 %, five (8 %) had an inadequate preparation, the CCE polyp detection rate was high at 35 %. The sensitivity, specificity, positive and negative predictive values of CCE for significant disease were 81 %, 98 %, 93 % and 94 % respectively. In addition, three (5 %) significant small bowel diagnoses were made on CCE. FC and FIT were frequently elevated in patients with both colitis (5/7, 71 %) and high-risk adenomas (4/7 57 %). While both had a low positive predictive value for clinically significant disease, FIT 32 % and FC 26 %. Conclusions CCE is a safe and effective alternative to colonoscopy in symptomatic average risk patients with or without the addition of biomarker screening.
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Affiliation(s)
- Mohd Syafiq Ismail
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
- TAGG Research Centre, School of Medicine, Trinity College, Dublin, Ireland
| | - Serhiy Semenov
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
- TAGG Research Centre, School of Medicine, Trinity College, Dublin, Ireland
| | - Sandeep Sihag
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | | | | | - Phyllis Reill
- Department of Clinical Chemistry, Tallaght University Hospital, Dublin, Ireland
| | - Michael Kelly
- Department of Clinical Chemistry, Tallaght University Hospital, Dublin, Ireland
| | - Gerard Boran
- Department of Clinical Chemistry, Tallaght University Hospital, Dublin, Ireland
| | - Anthony O’Connor
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
- TAGG Research Centre, School of Medicine, Trinity College, Dublin, Ireland
| | - Niall Breslin
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - Sarah O’Donnell
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - Barbara Ryan
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - Deirdre McNamara
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
- TAGG Research Centre, School of Medicine, Trinity College, Dublin, Ireland
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Ma LQ, Han Q, Mei C. 2D/3D coordination polymers: treatment effect on the ulcerative colitis by reducing the inflammatory response. INORG NANO-MET CHEM 2020. [DOI: 10.1080/24701556.2020.1806882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Li-Qun Ma
- Department of Anorectal Surgery, Wenjiang District People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Qiang Han
- ICU, Chengdu Fifth People’s Hospital, Chengdu, Sichuan, China
| | - Chen Mei
- Department of Rehabilitation, Beijing Hospital, Beijing, China
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