Prospective multicenter evaluation of colon capsule examination indicated by colonoscopy failure or anesthesia contraindication.
OBJECTIVE
In France, in about 5% of cases colonoscopies are incomplete or temporarily contraindicated.We tested the diagnostic yield of colon capsule endoscopy (CCE) in these patients.


METHODS
In a prospective study, in 17 French centers, inclusion criteria were colonoscopy failure or general disease that excluded colonoscopy with anesthesia. Patients underwent CCE using the first-generation PillCam Colon capsule. The main end point was CCE diagnostic yield, defined as identification of a colorectal lesion that directly explained symptoms or necessitated a diagnostic or therapeutic examination. A secondary objective was to test a simplified Movi-Prep colon cleansing. Follow-up to identify missed symptomatic cancer was scheduled.


RESULTS
CCE showed positive findings in 36 patients (diagnostic yield 33.6 %), among whom 23 subsequently underwent therapeutic intervention. Among 64 patients with negative capsule findings, 9 had a complementary procedure showing adenomas in only 1 case. CCE was incomplete in 7/107 patients. Colonoscopy was done in one patient to retrieve a capsule retained in the left colon, and sigmoidoscopy in 11 because the rectum was not reached. No colorectal cancer was diagnosed during the follow-up period. Colon cleansing with MoviPrep was rated good or excellent in 75.9% of cases.


CONCLUSIONS
This study shows the feasibility and the usefulness of CCE in the situation of colonoscopy failure or contraindication. The colon capsule modality should be tested against other available approaches, such as virtual colonoscopy or repeat colonoscopy by an expert.
Department of Gastroenterology, Hôpital Edouard Herriot, Lyon, France. mathieu.pioche@chu-lyon.fr
M
M
Pioche
A
A
de Leusse
B
B
Filoche
P A
PA
Dalbiès
P
P
Adenis Lamarre
P
P
Jacob
J L
JL
Gaudin
P
P
Coulom
J C
JC
Letard
E
E
Borotto
A
A
Duriez
J-M
JM
Chabaud
D
D
Crampon
R
R
Gincul
P
P
Levy
E
E
ben-Soussan
M
M
Garret
J
J
Lapuelle
J C
JC
Saurin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D053704:Capsule Endoscopy; D003113:Colonoscopy; D000075202:Contraindications; D005240:Feasibility Studies; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017211:Treatment Failure