Advances in capsule endoscopy: PillCam Colon
Imagine swallowing a tiny, disposable camera encased in a pill as an alternative to a colonoscopy. Meet the PillCam Colon, an ingestible camera created by Given Imaging that was recently approved by FDA. This video capsule contains two miniature color video cameras on each end of the pill, transmitting 4 to 35 frames per second. This translates to approximately 30,000 pictures that are made into a video for a physician to view.1
The PillCam Colon falls under the spectrum of capsule endoscopy, an advancing screening technique for colorectal cancer. According to the European Guidelines for Colon Capsule Endoscopy, colorectal cancer screening is still disappointingly low, and innovations such as the PillCam Colon have the potential to improve screening rates.2
PillCam is currently approved in the United States for patients who have had incomplete colonoscopies not caused by poor prep. Incomplete colonoscopies occur when the colonoscope is unable to provide a thorough exam of the entire colon, which, although not common, can affect up to 10% of procedures.3 Normally, these patients will be followed up with a complete colonoscopy, but adherence proves a barrier in 18% to 46% of patients after an incomplete colonoscopy.3
A worthy recommendation?
Colon cancer is the second leading cause of cancer death in the United States and one of the most commonly diagnosed cancers in men and women globally. Death claims one in three lives in those who develop colorectal cancer.4 CDC recommends screening for colorectal cancer beginning at age 50 years and continuing until age 75 years.5 What notable advantages can the PillCam Colon offer for improvement of care? First, it is a minimally invasive complementary option to existing colonoscopy. Its use can reduce the risk of bowel perforation and avoid the need for sedation. Thus, it may be a viable option for patients who avoid screening through colonoscopy because of the unpleasantness and invasiveness of the procedure.
Colon capsule endoscopy is considered safe and feasible when used in average-risk individuals.2 The sensitivity rate for the PillCam Colon is greater than the 50% cutoff recommended by the American Cancer Society to define a test acceptable for screening purposes.2 It cannot, however, remove any precancerous adenomatous polyps detected along the intestinal track, an advantage that still belongs to colonoscopies. If the camera captures images of abnormal growth, the patient will need a follow-up exam with a colonoscopy.
Benefits and risks
The PillCam Colon comes with a price tag of roughly $500, a fraction of the thousands of dollars needed for a colonoscopy. Capsule retention is rare but remains a possibility, with eight reported cases of retention to date.6 The risks of PillCam capsule endoscopy include capsule retention, aspiration, or skin irritation. It is also contraindicated for patients with known or suspected GI obstruction, structures, fistulas, or cardiac pacemakers and other implanted electromedical devices, and for those with swallowing disorders.6 As health professionals, pharmacists should be aware of both benefits and risks of this new device so they can make appropriate recommendations to patients who may need a minimally invasive option to colon screening.
For a brief overview of the PillCam Colon procedure, see http://youtu.be/uJ5URbxyVxU.
- Endoscopy. 2012;44(5):527–36.