By JanakyReviewed by Lexie CornerSep 10 2024Colon capsule endoscopy (CCE), a subset of capsule or video capsule endoscopy, offers a non-invasive method for examining the colon and detecting colonic pathology.1 A key advantage of this advanced technology is its ability to screen for colorectal cancer more comfortably than traditional methods, potentially improving early detection and accessibility.
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Researchers are working on enhancing these capsules for more precise movement and additional functions, such as taking tissue samples or delivering targeted treatments.2 Currently used mainly as a supplement to traditional colonoscopy, CCE has the potential to transform colorectal screening and diagnosis in the future.
How Does CCE Work?
The second-generation CCE is compact (11.6 mm x 31.5 mm) and designed to be swallowed by patients. This capsule, similar in size to a vitamin pill, contains two disposal cameras—one at each end—each offering a 172-degree field of view.3 Together, these cameras provide nearly complete coverage of the colon, continuously capturing images as the capsule moves through the digestive system.
The capsule's adaptive frame rate adjusts the image capture speed based on the capsule's movement, ranging from 4 to 35 images per second.3 This optimization helps extend battery life and reduces unnecessary data that could complicate analysis.
During the procedure, the capsule communicates with an external data recorder worn by the patient. The recorder monitors the capsule’s position and adjusts the image capture rate accordingly. 4 The recorder also provides real-time instructions to the patient via visual and audio cues, such as when to take additional medications to aid the capsule's movement through the digestive tract.
Once the capsule is excreted through the rectum, the data from the recorder is transferred to a workstation.5 Here, dedicated software processes the images, creating a comprehensive video for medical review and diagnosis.
Colon Preparation Requirements for CCE
The CCE procedure necessitates a thoroughly cleansed colon, as the capsule itself cannot perform cleansing during the scan. Proper bowel preparation is crucial, as even small amounts of debris can obstruct the capsule's view, potentially leading to missed polyps and reducing the accuracy of the results.1
The preparation protocol includes a combination of a polyethylene glycol solution with sodium phosphate boosts, designed to enable a complete examination in most cases.1
This protocol has been refined with specific timing, dosage adjustments, and dietary recommendations, such as following a low-residue or liquid diet the day before the procedure. In some cases, suppositories or prokinetics may be used to facilitate capsule excretion.1
Advantages of CCE Over Traditional Methods
CCE offers a more patient-friendly alternative to traditional colonoscopy by eliminating the need for sedation, air insufflation, or the insertion of a lengthy tube into the colon.3 Its non-invasive nature and lack of sedation allow patients to continue their daily activities with minimal discomfort during the procedure.
Modern CCE techniques demonstrate comparable accuracy to traditional colonoscopy in detecting colonic lesions, such as polyps and tumors. The less intimidating nature of CCE can improve patient compliance with colorectal cancer screening recommendations.
Another key advantage of CCE is that it can be performed outside of a hospital setting, such as in a clinic or even at home, reducing the need for hospital visits.4
The procedure is simple: patients swallow the capsule provided by the hospital, wear a receiver belt to capture the data, and can leave the clinic. This convenience reduces the strain on healthcare facilities and makes colorectal screening more accessible to a wider population.
Applications of CCE in Diagnosis
Medtronic has made significant advancements in CCE technology with its PillCam™ capsule range. Approved by the US FDA in 2017, the PillCam™ offers a 336-degree field of view through dual cameras and features an adaptive image capture rate.
This design allows the capsule to function for up to 12 hours, capturing up to 50,000 images throughout the gastrointestinal tract.6 PillCam™ has demonstrated similar effectiveness to traditional colonoscopy and is more effective than computed tomographic colonography for detecting colonic issues.
CCE has proven highly effective in detecting polyps and other abnormalities in the colon. Research shows CCE has a sensitivity of 79–96 % for smaller polyps (greater than 6 mm) and 84–97 % for larger polyps (greater than 10 mm).1 Additionally, it has a colorectal cancer detection rate of up to 93 % in completed procedures, making it a strong option for early cancer screening.1
CCE is also valuable in diagnosing and monitoring inflammatory bowel diseases like Crohn’s disease and ulcerative colitis.1 These conditions often require regular assessments to monitor disease progression, evaluate treatment efficacy, and screen for cancer.
CCE provides a non-invasive, comprehensive method for examining the entire digestive tract, particularly the small intestine, which is commonly affected by Crohn’s disease.
CCE: Current Challenges and Research
CCE is generally safe and well-tolerated by patients, but some challenges remain, particularly in terms of bowel preparation and battery life.
The Scottish Capsule Programme (ScotCap) reported re-investigation rates as high as 63 % for symptomatic patients and 70 % for those under surveillance.1 Further research is needed to identify the factors contributing to incomplete CCE exams and to refine patient selection, especially for lower-risk individuals.
The reading process for CCE is time-consuming, with an average exam taking around 55 minutes to review.1 Researchers are exploring the use of artificial intelligence (AI) in CCE to accelerate the reading process and enhance detection rates. Recent reviews of AI applications in colon capsule endoscopy have shown promising results, indicating potential for future integration into routine practice.1
Efforts are underway to enhance the affordability of CCE technology, making it more accessible to a wider range of patients. Current guidance indicates that increasing patient participation in surveillance programs could further improve its overall value.1 For CCE to gain broader adoption, a comprehensive and updated review of its economic viability is crucial.
Highlights and Future Directions
CCE offers a promising non-invasive alternative to traditional colonoscopy, improving patient compliance with colorectal screening and monitoring.7
However, challenges remain, including the need for thorough bowel preparation, battery limitations, and the time-consuming nature of the reading process. One notable issue is the lack of standardized training for interpreting CCE results, with variations between institutions affecting reading quality.7
As healthcare services face growing demands, CCE's ability to enhance diagnostic accuracy and efficiency, particularly with AI integration, positions it as a key player in future colorectal healthcare.
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References and Further Reading
- Gibbons, E., Kelly, OB., Hall, B. (2023). Advances in colon capsule endoscopy: a review of current applications and challenges. Frontiers in Gastroenterology. DOI: 10.3389/fgstr.2023.1316334, https://www.frontiersin.org/journals/gastroenterology/articles/10.3389/fgstr.2023.1316334/full
- Hale, MF., Sidhu, R., McAlindon, ME. (2014). Capsule endoscopy: current practice and future directions. World journal of gastroenterology: WJG. DOI: 10.3748%2Fwjg.v20.i24.7752, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4069303/
- Tal, AO., Vermehren, J., Albert, JG. (2014). Colon capsule endoscopy: current status and future directions. World Journal of Gastroenterology: WJG. DOI: 10.3748%2Fwjg.v20.i44.16596, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4248202/
- Cancer Research UK. (2021). Capsule Endoscopy. [Online]. Cancer Research UK. Available at: https://www.cancerresearchuk.org/about-cancer/tests-and-scans/capsule-endoscopy
- Oka, P., McAlindon, M., Sidhu, R. (2022). Capsule endoscopy-a non-invasive modality to investigate the GI tract: out with the old and in with the new? Expert Review of Gastroenterology & Hepatology. DOI: 10.1080/17474124.2022.2089113, https://www.tandfonline.com/doi/full/10.1080/17474124.2022.2089113#abstract
- Waghmare, PV., Panchal, CV., Poul, BN. (2013). Swallowable wireless capsular endoscopy: a novel breakthrough in the biomedical industry and future progress. International Journal of Pharmaceutical Sciences and Research. DOI: 10.13040/IJPSR.0975-8232.4(11).4133-44, https://mcpnilanga.org/uploads/539fef27dc863.pdf
- Koulaouzidis, A., Baatrup, G. (2023). Current status of colon capsule endoscopy in clinical practice. Nature Reviews Gastroenterology & Hepatology. DOI: 10.1038/s41575-023-00783-2, https://www.nature.com/articles/s41575-023-00783-2
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