Colon capsule endoscopy (CCE) is a modern, non-invasive method for large bowel visualization, offering a less invasive alternative to traditional colonoscopy (TC). While TC remains the gold standard for comprehensive large bowel assessment, including the detection and treatment of various conditions, the effectiveness of CCE in detecting polyps is less established.

To systematically review and compare the polyp detection rates (PDR) of CCE and TC.

A systematic literature search was conducted using four scientific databases: CINAHL, MEDLINE via EBSCO, Cochrane Library, and MEDLINE/PubMed. A standardized search command was utilized to ensure consistency. Full papers were retrieved if they compared PDR between CCE and TC and involved patients over 18 years old. A meta-analysis was then conducted using the meta package in R software.

Initially, 339 articles were identified, with 128 duplicates and 15 non-English articles excluded, leaving 196 for screening. After further exclusions, 9 articles were included in the review. The meta-analysis revealed minimal differences in PDR between CCE and TC. The pooled PDR for TC was 0.61 (95%CI: 0.48–0.72), and for CCE, it was 0.61 (95%CI: 0.48–0.73). The overall comparison of the pooled PDR of both methods was 0.96 (95%CI: 0.90–1.02), indicating that CCE is non-inferior to TC.

CCE has emerged as a modern and safe diagnostic alternative to TC for polyp detection, demonstrating non-inferiority when compared to the conventional method.

• Colon capsule endoscopy
• Colonoscopy
• Polyp detection rate
• Polyp
• Adenoma
• Colorectal cancer

• Crohn’s disease management
• biologics
• capsule endoscopy
• remission
• surgery
• symptomatology

• colorectal cancer
• grounded theory
• initial tests
• qualitative interview
• screening

Colon screening programs have reduced colon cancer mortality. Population screening should be minimally invasive, safe, acceptably sensitive, cost-effective, and scalable. The range of screening modalities include guaiac or immunochemical fecal occult blood testing and CT colonography and colonoscopy. A number of carefully controlled studies concur that second-generation capsule endoscopy has excellent sensitivity for polyp detection and a high negative predictive value. Colon capsules fulfill the screening expectation of safety, high sensitivity for polyp detection, and patient acceptance, and appear to straddle the divide between occult blood testing and colonoscopy. While meeting these criteria, there remains the challenges of scaling, capsule practitioner training, resource allocation, and implementing change of practice. Like CT colonography, capsule screening presents the clinician with a decision on the threshold for colonoscopy referral. Overall, colon capsules are an invaluable tool in polyp detection and colon screening and offer a filter that determines “who needs a colonoscopy?”.

Background: Colon capsule endoscopy (CCE) is an alternative for patients unwilling or with contraindications for conventional colonoscopy. Colorectal cancer screening may benefit greatly from widespread acceptance of a non-invasive tool such as CCE. However, reviewing CCE exams is a time-consuming process, with risk of overlooking important lesions. We aimed to develop an artificial intelligence (AI) algorithm using a convolutional neural network (CNN) architecture for automatic detection of colonic protruding lesions in CCE images. An anonymized database of CCE images collected from a total of 124 patients was used. This database included images of patients with colonic protruding lesions or patients with normal colonic mucosa or with other pathologic findings. A total of 5715 images were extracted for CNN development. Two image datasets were created and used for training and validation of the CNN. The AUROC for detection of protruding lesions was 0.99. The sensitivity, specificity, PPV and NPV were 90.0%, 99.1%, 98.6% and 93.2%, respectively. The overall accuracy of the network was 95.3%. The developed deep learning algorithm accurately detected protruding lesions in CCE images. The introduction of AI technology to CCE may increase its diagnostic accuracy and acceptance for screening of colorectal neoplasia.

• artificial intelligence
• colon capsule endoscopy
• colorectal neoplasia
• convolutional neural network

Colon capsule endoscopy (CCE) was introduced nearly two decades ago. Initially, it was limited by poor image quality and short battery time, but due to technical improvements, it has become an equal diagnostic alternative to optical colonoscopy (OC). Hastened by the coronavirus disease 2019 pandemic, CCE has been introduced in clinical practice to relieve overburdened endoscopy units and move investigations to out-patient clinics. A wider adoption of CCE would be bolstered by positive patient experience, as it offers a diagnostic investigation that is not inferior to other modalities. The shortcomings of CCE include its inability to differentiate adenomatous polyps from hyperplastic polyps. Solving this issue would improve the stratification of patients for polyp removal. Artificial intelligence (AI) has shown promising results in polyp detection and characterization to minimize incomplete CCEs and avoid needless examinations. Onboard AI appears to be a needed application to enable near-real-time decision-making in order to diminish patient waiting times and avoid superfluous subsequent OCs. With this letter, we discuss the potential and role of AI in CCE as a diagnostic tool for the large bowel.

• Video capsule endoscopy
• Wireless capsule endoscopy
• Artificial intelligence
• Colonic polyps
• Endoscopic surgical procedures
• Colon neoplasm

• Artificial Intelligence
• COVID-19
• Capsule Endoscopy/methods
• Colonic Polyps/diagnostic imaging
• Colonoscopy/methods
• Colorectal Neoplasms/diagnosis
• Gastroenterology
• Humans

The COVID-19 pandemic has caused considerable disruption in healthcare services and has had a substantial impact on the care of patients with chronic diseases, such as inflammatory bowel disease. Endoscopy services were significantly restricted, resulting in long waiting lists. There has been a growing interest in the use of capsule endoscopy in the diagnostic pathway and management of these patients. This review explores the published literature on the role of colon capsule endoscopy in ulcerative colitis and Crohn’s disease as a method for mucosal assessment of extent, severity, and response to treatment. Colon capsule preparation regimens and scoring systems are reported. The studies indicate that, despite inherent limitations of minimally invasive capsule endoscopy, there is increasing evidence to support the use of the second-generation colon capsule in inflammatory bowel disease evaluation, providing an additional pathway to expedite investigation of appropriate patients especially during and after the pandemic.

In the constantly developing era of minimal diagnostic invasiveness, the role of colon capsule endoscopy in colonic examination is being increasingly recognised, especially in the context of curtailed endoscopy services due to the COVID-19 pandemic. It is a safe diagnostic tool with low adverse event rates. As with other endoscopic modalities, various colon capsule endoscopy scores allow the standardisation of reporting and reproducibility. As bowel cleanliness affects CCE’s diagnostic yield, a few operator-dependent scores (Leighton–Rex and CC-CLEAR scores) and a computer-dependent score (CAC score) have been developed to grade bowel cleanliness objectively. CCE can be used to monitor IBD mucosal disease activity through the UCEIS and the panenteric CECDAIic score for UC and CD, respectively. CCE may also have a role in CRC screening, given similar sensitivity and specificity rates to conventional colonoscopy to detect colonic polyps ≥ 10 mm and CRC. Given CCE’s diagnostic yield and reproducible clinical scores with high inter-observer agreements, CCE is fast becoming a suitable alternative to conventional colonoscopy in specific patient populations.

• bowel preparation
• colon capsule endoscopy
• colonoscopy
• endoscopy score
• inflammatory bowel disease
• inter-observer agreement
• minimally invasive
• polyps

• asymptomatic individuals
• gastric tumors
• gastrointestinal lesions
• magnetic-controlled capsule endoscopy
• precancerous lesions

• Aged
• Colonography, Computed Tomographic/economics
• Colonoscopy/economics
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/diagnostic imaging
• Colorectal Neoplasms/economics
• Colorectal Neoplasms/pathology
• Cost-Benefit Analysis/economics
• DNA/chemistry
• DNA/isolation & purification
• Early Detection of Cancer/classification
• Early Detection of Cancer/economics
• Feces/chemistry
• Humans
• Middle Aged
• Occult Blood
• Quality-Adjusted Life Years

• P30 CA008748 NCI NIH HHS
• U01 CA199335 NCI NIH HHS
• National Cancer Institute
• Cancer Intervention and Surveillance Modeling Network

• Bowel preparation
• CT colonography
• Colon capsule
• Colon capsule endoscopy
• Colonoscopy
• Colorectal cancer screening
• Crohn disease
• Incomplete colonoscopy
• Inflammatory bowel disease
• Ulcerative colitis

• Capsule Endoscopy/instrumentation
• Capsule Endoscopy/methods
• Cathartics/administration & dosage
• Colonic Diseases/diagnosis
• Colonic Polyps/diagnosis
• Colonography, Computed Tomographic
• Colonoscopy/instrumentation
• Colonoscopy/methods
• Colorectal Neoplasms/diagnosis
• Early Detection of Cancer/methods
• Humans
• Inflammatory Bowel Diseases/diagnosis

• Colorectal cancer
• Cost-effectiveness
• Diagnostic procedures
• Screening

• Capsule Endoscopy
• Celiac Disease
• Colonoscopy
• Crohn’s Disease
• Endoscopy
• Gastrointestinal Bleeding
• Video Capsule

• Capsule endoscopy
• Colonoscopy
• Colorectal cancer
• IBD
• Polyp

• Capsule endoscopy
• Colonography, computed tomographic
• Colonoscopy

• Adult
• Capsules
• Deglutition
• Electric Power Supplies
• Equipment Design
• Fluorescein/chemistry
• Fluorescein/pharmacokinetics
• Fluorometry/instrumentation
• Gastrointestinal Hemorrhage/diagnosis
• Humans
• Male
• Optical Phenomena
• Triage/methods
• Wireless Technology

• 1U54-CA119349 NCI NIH HHS

• Colon Cancer
• Colon Capsule-2
• Detection
• Participation
• Tumor

• Barrett's oesophagus
• bowel preparation
• colon capsule
• colorectal polyps
• esophageal capsule
• esophageal varices

• accuracy
• colon capsule
• mucosal inflammation
• safety
• ulcerative colitis

Colon capsule endoscopy (CCE; PillCam Colon; Given Imaging; Yoqneam, Israel) is a minimally invasive wireless technique for the visualization of the colon. With the recent introduction of the second generation colon capsule the diagnostic accuracy of CCE for polyp detection has significantly improved and preliminary data suggest it may be useful to monitor mucosal inflammation in patients with inflammatory bowel disease. Limitations include the inability to take biopsies and the procedural costs. However, given the potentially higher acceptance within an average risk colorectal cancer (CRC) screening population, its usefulness as a screening tool with regard to CRC prevention should be further evaluated.

• Capsule endoscopy
• Endoscopy
• Colon capsule endoscopy
• Colonoscopy
• Colorectal cancer
• Colon
• Colonic capsule endoscopy
• Inflammatory bowel disease

• Capsule Endoscopes/trends
• Capsule Endoscopy/instrumentation
• Capsule Endoscopy/trends
• Colon/pathology
• Colonic Diseases/pathology
• Colonoscopy/instrumentation
• Colonoscopy/trends
• Contraindications
• Diffusion of Innovation
• Equipment Design
• History, 21st Century
• Humans
• Patient Selection
• Predictive Value of Tests
• Prognosis

• Capsule endoscopy
• Colon
• Gastrointestinal endoscopy
• Incomplete colonoscopy
• Ulcerative colitis

• Capsule Endoscopy
• Colitis, Ulcerative/pathology
• Colitis, Ulcerative/therapy
• Colon/pathology
• Colonoscopy
• Colorectal Neoplasms/pathology
• Early Detection of Cancer/methods
• Humans
• Intestinal Mucosa/pathology
• Predictive Value of Tests
• Prognosis
• Severity of Illness Index
• Wound Healing

Capsule endoscopy (CE) has transformed investigation of the small bowel providing a non-invasive, well tolerated means of accurately visualising the distal duodenum, jejunum and ileum. Since the introduction of small bowel CE thirteen years ago a high volume of literature on indications, diagnostic yields and safety profile has been presented. Inclusion in national and international guidelines has placed small bowel capsule endoscopy at the forefront of investigation into suspected diseases of the small bowel. Most commonly, small bowel CE is used in patients with suspected bleeding or to identify evidence of active Crohn’s disease (CD) (in patients with or without a prior history of CD). Typically, CE is undertaken after upper and lower gastrointestinal flexible endoscopy has failed to identify a diagnosis. Small bowel radiology or a patency capsule test should be considered prior to CE in those at high risk of strictures (such as patients known to have CD or presenting with obstructive symptoms) to reduce the risk of capsule retention. CE also has a role in patients with coeliac disease, suspected small bowel tumours and other small bowel disorders. Since the advent of small bowel CE, dedicated oesophageal and colon capsule endoscopes have expanded the fields of application to include the investigation of upper and lower gastrointestinal disorders. Oesophageal CE may be used to diagnose oesophagitis, Barrett’s oesophagus and varices but reliability in identifying gastroduodenal pathology is unknown and it does not have biopsy capability. Colon CE provides an alternative to conventional colonoscopy for symptomatic patients, while a possible role in colorectal cancer screening is a fascinating prospect. Current research is already addressing the possibility of controlling capsule movement and developing capsules which allow tissue sampling and the administration of therapy.

• Capsule endoscopy
• Small bowel
• Indications
• Technology
• Oesophageal
• Colon

• Capsule Endoscopy/trends
• Colonoscopy/trends
• Diffusion of Innovation
• Duodenoscopy/trends
• Esophagoscopy/trends
• Forecasting
• Gastrointestinal Diseases/diagnosis
• Gastrointestinal Diseases/pathology
• Gastrointestinal Tract/pathology
• Humans
• Predictive Value of Tests

• bowel preparation
• capsule colonoscopy
• regimens
• review

• Bowel
• Cancer
• Colorectal
• FIT
• FOBT
• Faecal immunochemical test
• Faecal occult blood
• Screening

• cancer prevention
• capsule endoscopy
• colon
• colonoscopy
• colorectal cancer

Colon capsule endoscopy (CCE) was developed for the evaluation of colorectal pathology. In this study, our aim was to assess if a dual-camera analysis using CCE allows better evaluation of the whole gastrointestinal (GI) tract compared to a single-camera analysis.

We included 21 patients (12 males, mean age 56.20 years) submitted for a CCE examination. After standard colon preparation, the colon capsule endoscope (PillCam Colon™) was swallowed after reinitiation from its “sleep” mode. Four physicians performed the analysis: two reviewed both video streams at the same time (dual-camera analysis); one analyzed images from one side of the device (“camera 1”); and the other reviewed the opposite side (“camera 2”). We compared numbers of findings from different parts of the entire GI tract and level of agreement among reviewers.

A complete evaluation of the GI tract was possible in all patients. Dual-camera analysis provided 16% and 5% more findings compared to camera 1 and camera 2 analysis, respectively. Overall agreement was 62.7% (kappa = 0.44, 95% CI: 0.373–0.510). Esophageal (kappa = 0.611) and colorectal (kappa = 0.595) findings had a good level of agreement, while small bowel (kappa = 0.405) showed moderate agreement.

The use of dual-camera analysis with CCE for the evaluation of the GI tract is feasible and detects more abnormalities when compared with single-camera analysis.

• capsule endoscopy
• colon
• gastrointestinal tract
• small bowel

• colorectal cancer
• screening
• polyp
• adenoma
• cost-effectiveness
• cost-utility

Capsule endoscopy was conceived by Gabriel Iddan and Paul Swain independently two decades ago. These applications include but are not limited to Crohn’s disease of the small bowel, occult gastrointestinal bleeding, non steroidal anti inflammatory drug induced small bowel disease, carcinoid tumors of the small bowel, gastro intestinal stromal tumors of the small bowel and other disease affecting the small bowel. Capsule endoscopy has been compared to traditional small bowel series, computerized tomography studies and push enteroscopy. The diagnostic yield of capsule endoscopy has consistently been superior in the diagnosis of small bowel disease compared to the competing methods (small bowel series, computerized tomography, push enteroscopy) of diagnosis. For this reason capsule endoscopy has enjoyed a meteoric success. Image quality has been improved with increased number of pixels, automatic light exposure adaptation and wider angle of view. Further applications of capsule endoscopy of other areas of the digestive tract are being explored. The increased transmission rate of images per second has made capsule endoscopy of the esophagus a realistic possibility. Technological advances that include a double imager capsule with a nearly panoramic view of the colon and a variable frame rate adjusted to the movement of the capsule in the colon have made capsule endoscopy of the colon feasible. The diagnostic rate for the identification of patients with polyps equal to or larger than 6 mm is high. Future advances in technology and biotechnology will lead to further progress. Capsule endoscopy is following the successful modern trend in medicine that replaces invasive tests with less invasive methodology.

• Capsule endoscopy
• Cancer screening
• Colon cancer
• Artificial intelligence
• Technology

Since the first reports almost ten years ago, wireless capsule endoscopy has gained new fields of application. Colon capsule endoscopy represents a new diagnostic technology for colonic exploration. Clinical trials have shown that colon capsule endoscopy is feasible, accurate and safe in patients suffering from colonic diseases and might be a valid alternative to conventional colonoscopy in selected cases such as patients refusing conventional colonoscopy or with contraindications to colonoscopy or when colonoscopy is incomplete. Despite the enthusiasm surrounding this new technique, few clinical and randomized controlled trials are to be found in the current literature, leading to heterogeneous or controversial results. Upcoming studies are needed to prove the substantial utility of colon capsule endoscopy for colon cancer screening, especially in a low prevalence of disease population, and for other indications such as inflammatory bowel disease. Possible perspectives are critically analysed and reported in this paper.

• Colonoscopy
• Colorectal cancer
• Inflammatory bowel disease
• PillCam colon capsule
• Polyps
• Preparation

• CRC screening
• capsule endoscopy
• imaging innovations
• performance
• technical aspects