Muriel Frederic

Second-generation colon capsule endoscopy compared with colonoscopy

BACKGROUND Colon capsule endoscopy (CCE) represents a noninvasive technology that allows visualization of the colon without requiring sedation and air insufflation. A second-generation colon capsule endoscopy system (PillCam Colon 2) (CCE-2) was developed to increase sensitivity for colorectal polyp detection compared with the first-generation system. OBJECTIVE To assess the feasibility, accuracy, and safety of CCE-2 in a head-to-head comparison with colonoscopy. DESIGN AND SETTING Prospective, multicenter trial including 8 European sites. PATIENTS This study involved 117 patients (mean age 60 years). Data from 109 patients were analyzed. INTERVENTION CCE-2 was prospectively compared with conventional colonoscopy as the criterion standard for the detection of colorectal polyps that are ≥6 mm or masses in a cohort of patients at average or increased risk of colorectal neoplasia. Colonoscopy was independently performed within 10 hours after capsule ingestion or on the next day. MAIN OUTCOME MEASUREMENTS CCE-2 sensitivity and specificity for detecting patients with polyps ≥6 mm and ≥10 mm were assessed. Capsule-positive but colonoscopy-negative cases were counted as false positive. Capsule excretion rate, level of bowel preparation, and rate of adverse events also were assessed. RESULTS Per-patient CCE-2 sensitivity for polyps ≥6 mm and ≥10 mm was 84% and 88%, with specificities of 64% and 95%, respectively. All 3 invasive carcinomas were detected by CCE-2. The capsule excretion rate was 88% within 10 hours. Overall colon cleanliness for CCE-2 was adequate in 81% of patients. LIMITATIONS Not unblinding the CCE-2 results at colonoscopy; heterogenous patient population; nonconsecutive patients. CONCLUSION In this European, multicenter study, CCE-2 appeared to have a high sensitivity for the detection of clinically relevant polypoid lesions, and it might be considered an adequate tool for colorectal imaging.

Could the colonic capsule PillCam Colon be clinically useful for selecting patients who deserve a complete colonoscopy?: results of clinical comparison with colonoscopy in the perspective of colorectal cancer screening.

OBJECTIVES:Preliminary studies have shown the possibility of detecting colonic polyps and tumors using the PillCam Colon capsule endoscope (CCE) (Given Imaging, Yoqneam, Israel). The aim of this study was to evaluate the ability of CCE to detect clinically relevant colonic findings as compared with colonoscopy, and further, to test the assumption that CCE used in the frame of colorectal cancer (CRC) screening could accurately discriminate patients deserving a complete colonoscopy.METHODS:A total of 128 patients (67 men, 55±14 years) with an indication of colonoscopy were investigated by CCE, followed by colonoscopy under general anesthesia on the next day. Bowel cleansing was carried out according to a previously published protocol (3 l polyethylene glycol+2 doses of sodium phosphate solution). All CCE recordings were read by the same physician and all colonoscopies, performed by the same operator, were blinded to each others results. The primary outcome of the study was the decision made by the CCE reader to indicate a colonoscopy, compared with the final result of the colonoscopy. Secondary outcomes were the agreement between CCE and colonoscopy for making a diagnosis of colorectal disease, as well as detection rate, number, and size of polyps.RESULTS:Two patients were excluded: one did not swallow the capsule and the other was diagnosed with a jejunal stenosis by the CCE. The CCE found at least one clinically relevant colonic finding in 71 patients (56.3%), and the colonoscopy results confirmed this finding in 56 patients, showing a sensitivity of CCE of 87.5% (confidence interval (CI) 79.4–95.6%) and a specificity of 75.8% (CI 65.4–86.2%). With a prevalence of 50.8% of clinically relevant findings at colonoscopy, the positive predictive value of CCE was 78.9%, and the negative predictive value (NPV) was 85.4%. The agreement between CCE and colonoscopy was significant for the detection of any colonic lesion (P<0.0001), polyps (P<0.001), as well as for the detection of the number (P<0.0001) and size (P=0.0083) of polyps. Tolerance of the procedure was excellent, and no complication was reported.CONCLUSIONS:In the setting of this study, CCE seemed to be effective in detecting clinically significant colonic findings in patients with an indication of colonoscopy. The high NPV and excellent tolerance of CCE suggest that it could be evaluated in large CRC-screening programs and further studies in screening conditions should also evaluate its cost–efficacy ratio.

V.02 Intérêt de l’entéroscope double-ballon pour explorer l’estomac, après chirurgie bariatrique

Introduction L’exploration endoscopique des patients operes d’un by-pass gastrique ou ayant une anastomose hepatico-jejunale sur une anse en Y est souvent difficile du fait de la longueur de l’anse afferente et de l’angle fixe au niveau de l’anastomose jejuno-jejunale. L’enteroscopie double ballon permet d’explorer ces patients, en tirant parti de la technique du double ballon et du surtube pour raccourcir l’anse jejunale en Y et ainsi acceder de maniere retrograde a l’estomac exclu. De plus, l’utilisation du surtube rend la progression de l’endoscope plus sure puisque les forces exercees par l’operateur pour avancer l’endoscope sont constamment transmises a la partie distale de l’endoscope. Patients et Methodes Nous avons utilise un enteroscope double ballon (EN450T20. Fujinon Optical Co., Ltd., Saitama, Japon) pour explorer 5 patients avec un bypass gastrique et ayant une indication d’examen endoscopique de l’estomac exclu et deux patients presentant une stenose d’une anastomose hepatico-jejunale sur anse en Y. L’estomac exclu a ete atteint chez 4 des 5 patients et l’anastomose hepatico-jejunale, chez les deux patients. Chez ces deux derniers patients, une dilatation a pu etre realisee au moyen d’un ballonnet hydrostatique, permettant dans un cas, l’evacuation d’un calcul sus-anastomotique responsable d’episodes d’angiocholite. Resultats Le film que nous presentons demontre le principe de cette technique d’exploration endoscopique, illustre les difficultes rencontrees pour catheteriser l’anse en Y et en discute les indications. Conclusion Le principe de l’endoscopie double ballon permet chez ces patients d’elargir le champ des explorations endoscopiques et ouvre de nouvelles possibilites diagnostiques et therapeutiques.