Is there a role for colon capsule endoscopy in acute disease?

Colon capsule endoscopy (CCE) was first put into clinical practice for the evaluation of the small bowel in patients presenting with a gastrointestinal bleed unsuccessfully diagnosed by upper GI endoscopy and colonoscopy. With the recent advent of new technology, there is improved visualization of the intestinal mucosa and subsequently a higher sensitivity for identification of mural pathology, as seen in many recent prospective studies. CCE has now been studied both in the US and in Europe as a modality for colon cancer screening as well as for the diagnosis of inflammatory bowel disease. When compared to conventional colonoscopy, CCE has been shown to have a sensitivity of greater than 88% for identifying 6 mm colonic polyps and over 90% for 1 cm polyps. Therefore its use as a screening tool for colon cancer must be evaluated. In patients suspected to have colitis secondary to inflammatory bowel disease (IBD), it has been shown to have 89% sensitivity for identifying active colonic inflammation. For higher risk patients that requiring urgent colonoscopy, CCE offers an attractive alternative with the potential for a reduced risk on iatrogenic injury. Colon capsule endoscopy may also play an important role in the diagnosis and surveillance of IBD with colonic manifestations. Colonoscopy during active severe disease is associated with an increased risk of perforation due to mucosal inflammation and friability, allowing us to consider CCE as a potentially safer alternative. CCE appears to be most useful for patients with acute lower GI bleeding, inflammatory bowel disease, colonic ischemia or other mucosal-based lesions.