Colon capsule endoscopy: Current status and future directions

Table 1 Comparison of technical features of first and second generation colon capsules

CCE	Year of introduction	Size (mm)	Field of view	Frame rate (images/s)	Frame rate in the upper intestines	Special features
PillCam Colon 1 (CCE-1)	2006	31 × 11	156°	4	Sleeping mode 1 h 45 min	-
PillCam Colon 2 (CCE-2)	2009	31.5 × 11.6	172°	4-35	14/min until first frame of small bowel	Adaptive Image rate, Graphic interface, Live imaging

CCE-1: First generation colon capsule endoscopy; CCE-2: Second generation colon capsule endoscopy.

Table 2 Complication rates reported from studies involving both first and second generation colon capsules n (%)

Ref.	Year	n	Complications		Major complications in detail
			Minor	Major
Schoofs et al[3]	2006	41	0	0	-
Eliakim et al[37]	2006	98	0	1	Perforation at colonoscopy
Van Gossum et al[10]	2009	320	26 (2.9%)	0	Associated to bowel preparation: 22/26
Eliakim et al[4]	2009	104	8 (7.7%)	1 (0.96%)	7/8 associated to bowel preparation
					1/1 urinary retention
Pilz et al[38]	2010	59	1 (1.69%)	1 (1.69%)	1/1 perforation nach Koloskopie
					1/1 skin reaction from capsule electrodes
Gay et al[39]	2010	128	0	0	-
Sacher-Huvelin et al[11]	2010	545	19 (3.5%)	3 (0.5%)	Heart failure, potentially associated to bowel preparation: patient died
					Bleeding at mucosectomy
					Perforation at colonoscopy
Spada et al[8]	2011	109	8 (6.8%)	1 (0.85%)	5/8 associated to bowel preparation
					2/8 fatigue
					1/8 pain
					1/1 perforation at colonoscopy
Herrerías-Gutiérrez et al[40]	2011	144	0	0	-
Hartmann et al[13]	2012	50	4 (8%)	1 (2%)	3/4 associated to bowel preparation
					1/1 perforation at colonoscopy
Kakugawa et al[14]	2012	64	1 (1.56%)	0	1/1 associated to bowel preparation
Total	-	1621	67 (4.1%)	8 (0.49%)	-

Most complications are suspected to derive from colonoscopy and/or bowel preparation regimen and not related to CCE. CEE: Colon capsule endoscopy.

Table 3 Four-point grading scale for objective description of the level of cleanliness of the colon during colon capsule endoscopy[41]

Cleansing level scale	Description	Categories
Poor	Inadequate; Large amount of fecal residue precludes a complete examination	Inadequate Quality of the investigation is significantly compromised
Fair	Inadequate but examination completed
	Enough feces or turbid fluid to prevent
	a reliable examination
Good	Adequate	AdequateQuality of the investigation is not significantly compromised
	Small amount of feces or turbid fluid not interfering with examination
Excellent	Adequate
	No more than small bits of adherent feces

Table 4 Diagnostic accuracy of colon capsule endoscopy for the detection of significant colon polyps (≥ 6 mm or ≥ 3 polyps)

Ref.	Year published	Colon capsule	Number of patients included	Sensitivity	Specificity	PPV	NPV
Schoofs et al[3]	2006	CCE-1	36	77%	70%	59%	84%
Eliakim et al[37]	2006	CCE-1	84	50%	83%	40%	88%
Van Gossum et al[10]	2009	CCE-1	320	64%	84%	-	-
Gay et al[39]	2010	CCE-1	126	87.5%	76%	79%	85%
Pilz et al[38]	2010	CCE -1	56	79%	54%	63%	71%
Sacher-Huvelin et al[11]	2010	CCE-1	545	39%	88%	47%	85%
Eliakim et al[4] second gen	2009	CCE-2	98	89%	76%	46%	97%
Spada et al[8]	2011	CCE-2	109	84%	64%	-	-
Rex et al[6]	2013	CCE-2	689	81%	93%	-	-

CCE-1: First generation colon capsule endoscopy; CCE-2: Second generation colon capsule endoscopy; PPV: Positive predictive value; NPV: Negative predictive value.

Table 5 Colon capsule endoscopy for incomplete colonoscopy or patients with contraindications for colonoscopy

Ref.	Year	n	CCE	Complete visualization of the colon by CCE + colonoscopy	Treatment decision influenced in …	Significant findings	Capsule retention
Pioche et al[23]	2012	102	CCE-1	93%	59%	34%	12 cases
Alarcón-Fernández et al[42]	2012	34	CCE-1	85%	59%	23.5%	-
Negreanu et al[43]	2013	67	CCE-2	77% (CCE)	-	34%	2 cases
				90% (CCE + colonoscopy)
Triantafyllou et al[44]	2013	75	CCE-1	91%	-	44%	-

CCE: Colon capsule endoscopy; CCE-1: First generation colon capsule endoscopy; CCE-2: Second generation colon capsule endoscopy.