Is Panenteric PillcamTM Crohn's Capsule Endoscopy Ready for Widespread Use? A Narrative Review

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. Pillcam^TM 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 Pillcam^TM 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.

Aspiration of a Video Capsule Placed Endoscopically Into the Duodenum Under General Anesthesia

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Accuracy of First- and Second-Generation Colon Capsules in Endoscopic Detection of Colorectal Polyps: A Systematic Review and Meta-analysis

BACKGROUND & AIMS

Colon capsule endoscopy (CCE) is a noninvasive technique used to explore the colon without sedation or air insufflation. A second-generation capsule was recently developed to improve accuracy of detection, and clinical use has expanded globally. We performed a systematic review and meta-analysis to assess the accuracy of CCE in detecting colorectal polyps.

METHODS

We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and other databases from 1966 through 2015 for studies that compared accuracy of colonoscopy with histologic evaluation with CCE. The risk of bias within each study was ascertained according to Quality Assessment of Diagnostic Accuracy in Systematic Reviews recommendations. Per-patient accuracy values were calculated for polyps, overall and for first-generation (CCE-1) and second-generation (CCE-2) capsules. We analyzed data by using forest plots, the I² statistic to calculate heterogeneity, and meta-regression analyses.

RESULTS

Fourteen studies provided data from 2420 patients (1128 for CCE-1 and 1292 for CCE-2). CCE-2 and CCE-1 detected polyps >6 mm with 86% sensitivity (95% confidence interval [CI], 82%-89%) and 58% sensitivity (95% CI, 44%-70%), respectively, and 88.1% specificity (95% CI, 74.2%-95.0%) and 85.7% specificity (95% CI, 80.2%-90.0%), respectively. CCE-2 and CCE-1 detected polyps >10 mm with 87% sensitivity (95% CI, 81%-91%) and 54% sensitivity (95% CI, 29%-77%), respectively, and 95.3% specificity (95% CI, 91.5%-97.5%) and 97.4% specificity (95% CI, 96.0%-98.3%), respectively. CCE-2 identified all 11 invasive cancers detected by colonoscopy.

CONCLUSIONS

The sensitivity in detection of polyps >6 mm and >10 mm increased substantially between development of first-generation and second-generation colon capsules. High specificity values for detection of polyps by CCE-2 seem to be achievable with a 10-mm cutoff and in a screening setting.

Use of enhancement algorithm to suppress reflections in 3-D reconstructed capsule endoscopy images

In capsule endoscopy (CE), there is research to develop hardware that enables ‘‘real’’ three-dimensional (3-D) video. However, it should not be forgotten that ‘‘true’’ 3-D requires dual video images. Inclusion of two cameras within the shell of a capsule endoscope though might be unwieldy at present. Therefore, in an attempt to approximate a 3-D reconstruction of the digestive tract surface, a software that recovers information-using gradual variation of shading-from monocular two-dimensional CE images has been proposed. Light reflections on the surface of the digestive tract are still a significant problem. Therefore, a phantom model and simulator has been constructed in an attempt to check the validity of a highlight suppression algorithm. Our results confirm that 3-D representation software performs better with simultaneous application of a highlight reduction algorithm. Furthermore, 3-D representation follows a good approximation of the real distance to the lumen surface.

A multicenter, prospective, randomized comparison of a novel signal transmission capsule endoscope to an existing capsule endoscope

BACKGROUND

MiroCam, a capsule endoscope, uses a novel transmission technology, electric-field propagation, which uses the human body as a conduction medium for data transmission.

OBJECTIVE

To compare the ability of the MiroCam (MC) and PillCam (PC) to identify sources of obscure GI bleeding (OGIB).

DESIGN

Prospective, multicenter, comparative study.

SETTING

Six academic hospitals.

PATIENTS

A total of 105 patients with OGIB.

INTERVENTION

Patients ingested both the MC and PC capsules sequentially in a randomized fashion.

MAIN OUTCOME MEASUREMENTS

Concordance of rates in identifying a source of OGIB, operational times, and rates of complete small-bowel examination.

RESULTS

Data analysis resulted in 43 (48%) "abnormal" cases identifying a source of OGIB by either capsule. Twenty-four cases (55.8%) were positive by both capsules. There was negative agreement in 46 of 58 cases (79.3%). The κ index was 0.547 (χ(2) = 1.32; P = .36). In 12 cases, MC positively identified a source that was not seen on PC, whereas in 7 cases, PC positively identified a source that was not seen on MC. MC had a 5.6% higher rate of detecting small-bowel lesions (P = .54). MC captured images at 3 frames per second for 11.1 hours, and PC captured images at 2 frames per second for 7.8 hours (P < .0001). Complete small-bowel examination was achieved in 93.3% for MC and 84.3% for PC (P = .10).

LIMITATIONS

Readers were not blinded to the particular capsule they were reading.

CONCLUSION

A positive diagnostic finding for OGIB was identified by either capsule in 48% of cases. The concordance rate between the 2 capsules was comparable to that of prior studies in identifying sources of small-bowel bleeding. The longer operational time of the MC may result in higher rates of complete small-bowel examination, which may, in turn, translate into a higher rate of detecting small-bowel lesions. (

CLINICAL TRIAL REGISTRATION NUMBER

NCT00878982.).

Upper oesophageal images and Z-line detection with 2 different small-bowel capsule systems

Transmission of oesophageal images may vary between different small-bowel capsule endoscopy models. A retrospective review of 100 examinations performed with 2 different Small-bowel capsule endoscopy (SBCE) systems (PillCam^® and MiroCam^®) was performed. The oral cavity/aero-digestive tract (i.e., tongue, uvula and/or epiglottis) was captured/identified in almost all (99%) of PillCam^® videos but in none of MiroCam^® cases, P < 0.0001. Furthermore, oesophageal images (i.e., from the upper oesophageal sphincter to the Z-line were captured in 99% of PillCam^® videos (mean ± SD, 60.5 ± 334.1 frames, range: 0-3329 frames) and in 66% of MiroCam^® cases (mean ± SD, 11.1 ± 46.5 frames, range: 0-382 frames), P < 0.0001. The Z-line was identified in 42% of PillCam^® videos and 17% of MiroCam^®, P = 0.0002. This information might be useful when performing SBCE in patients with high risks for aspiration.

Blue mode does not offer any benefit over white light when calculating Lewis score in small-bowel capsule endoscopy

AIM: To check the usefulness of blue mode (BM) review in lewis score (LS) calculation, by comparing it with respective LS results obtained by white light (WL) small-bowel capsule endoscopy (SBCE) review and mucosal inflammation as reflected by faecal calprotectin (FC) levels, considered as ‘gold standard’ for this study.

METHODS: Computational analysis of our SBCE database to identify patients who underwent SBCE with PillCam^® and had FC measured within a 30-day period from their test. Only patients with prior colonoscopy were included, to exclude any colon pathology-associated FC rise. Each small bowel tertile was reviewed (viewing speed 8 fps) with WL and BM, in a back-to-back mode, by a single experienced reviewer. LS were calculated after each WL and BM reviews. Pearson rank correlation (rho, r) statistic was applied.

RESULTS: Twenty-seven (n = 27, 20F/7M) patients were included. Thirteen (n = 13) had SBCE with PillCam^®SB1, and the remainder (n = 14) with PillCam^®SB2. The median level of FC in this cohort was 125 μg/g. LS (calculated in WL SBCE review) correlation with FC levels was r = 0.490 (P = 0.01), while for BM review and LS correlation with FC was r = 0.472 (P = 0.013).

CONCLUSION: Although BM is believed to enhance mucosal details i.e., small mucosal breaks, it did not perform better than WL in the calculation of LS in our cohort.