Seit dem 1.7.2014 ist die Kapselendoskopie des Dünndarms (KE) in den Leistungskatalog der gesetzlichen Krankenkassen als „Kassenleistung“ aufgenommen. Außerdem konnten sich alle niedergelassenen Gastroenterologen und (bis zum 31.12.14) Internisten um eine Zulassung bemühen. So allmählich werden die in den QM-Vereinbarungen (s. Homepage der KBV) festgelegten Verfahren in den lokalen Kassenärztlichen Vereinigungen (KV) umgesetzt. Zeit für ein Resümee.

In this article, we aim to provide general principles as well as personal views for colonic capsule endoscopy. To allow an in-depth understanding of the recommendations, we also present basic technological characteristics and specifications, with emphasis on the current as well as the previous version of colonic capsule endoscopy and relevant software. To date, there is no scientific proof to support the optimal way of reading a colonic capsule endoscopy video, or any standards or guidelines exist. Hence, any advice is a mixture of recommendations by the capsule manufacturer and experts’ opinion. Furthermore, there is a paucity of data regarding the use of term(s) (pre-reader/reader-validator) in colonic capsule endoscopy. We also include a couple of handy tables in order to get info at a glance.

Background/Aims Reliable and especially widely accepted preventive measures are crucial to further reduce the incidence of colorectal cancer (CRC). Colon capsule endoscopy (CCE) might increase the screening numbers among patients unable or unwilling to undergo conventional colonoscopy. This registry trial aimed to document and determine the CCE indications, findings, complications, and adverse events in outpatient practices and clinics throughout Germany. Methods Patients undergoing CCE between 2010 and 2015 were enrolled in this prospective multicenter registry trial at six German centers. Patient demographics, outcomes, and complications were evaluated. Results A total of 161 patients were included. Of the CCE evaluations, 111 (68.9%) were considered successful. Pathological findings in the colon (n=92, 60.1%) and in the remaining gastrointestinal tract (n=38, 24.8%) were recorded. The main finding was the presence of polyps (n=52, 32.3%). Furthermore, five carcinomas (3.1%) were detected and histologically confirmed later. Adequate bowel cleanliness was more likely to be achieved in the outpatient setting (p<0.0001). Interestingly, 85 patients (55.6%) chose to undergo CCE based on personal motivation. Conclusions CCE seems to be a reliable and safe endoscopic tool for screening for CRC and detecting other diseases. Its patient acceptance and feasibility seems to be high, especially in the outpatient setting.

Colon capsule endoscopy (CCE) is a reliable method to detect colonic polyps in the well-prepared colon. As CCE evaluation can be time consuming, a new software algorithm might aid in reducing evaluation time. The aim of the study was to evaluate whether it is feasible to reliably detect colon polyps in CCE videos with a new software algorithm the “collage mode” (Rapid 8 Software, Covidien/Medtronic®). Twenty-nine CCE videos were randomly presented to three experienced and to three inexperienced investigators. Videos were evaluated by applying the collage mode. Investigation time was documented and the results (≥one polyp vs. no polyp) were compared with the findings of two highly experienced central readers who read the CCE videos in the standard mode beforehand. It took a median time of 9.8, 3.5, and 7.5 vs. 4.3, 4.6 and 12.5 min for experienced vs. inexperienced investigators to review the CCE videos. For detecting ≥one polyp vs. no polyp, sensitivity of 93.3%, 73.3%, and 93.3% was observed for the experienced and sensitivity of 46.7%, 33.3%, and 93.3% for the inexperienced CCE readers. Collage mode might allow for a quick review of CCE videos with a high polyp detection rate for experienced CCE readers. Future prospective studies should include CCE collage mode for rapid polyp detection to further prove the feasibility of practical colon polyp detection by CCE and possibly support the role of CCE as a screening tool in CRC prevention.

AIM:To evaluate the ability of PillCamColon2 to visualize colonic segments missed by incomplete optical colonoscopy (OC) and to assess the diagnostic yield.METHODS:This prospective multicentre study included 81 patients from nine centres who underwent second-generation colon capsule endoscopy (CCE) following incomplete OC performed by an experienced gastroenterologist (> 1000 colonoscopies). Patients with stenosis were excluded. According to patient preferences, CCE was performed the following day (protocol A) after staying on clear liquids and 0.75 L Moviprep in the morning or within 30 d after new split-dose Moviprep (protocol B). Boosts consisted of 0.75 L and 0.25 L Moviprep, and phospho-soda was given as a rescue if the capsule was not excreted after seven hours.RESULTS:Seventy-four patients were analysed (51% of them in group A; 49% in group B). Bowel cleansing was adequate in 67% of cases, and CCE could visualize colonic segments missed by incomplete colonoscopy in 90% of patients under protocol A and 97% of patients under protocol B (P = 0.35, n.s.). Significant polyps including adenocarcinoma were detected in 24% of cases. Detection rates for all polyps and significant polyps per patient were similar in both protocols. Polyps were found predominantly in the right colon (86%) in segments that were not reached by OC. Extracolonic findings - such as reflux esophagitis, suspected Barrett esophagus, upper GI-bleeding, gastric polyps, gastric erosions and angiectasia - were detected in eight patients. PillCamColon2 capsule was retained in the ileum of one patient (1.4%) without symptoms and removed during an uneventful resection for unknown Crohn's disease that was diagnosed as the cause of anemia, which was the indication for colonoscopy. CCE was well tolerated. One patient suffered from self-limiting vomiting after consuming the phospho-soda.CONCLUSION:Second-generation CCE using a low-volume preparation is useful after incomplete OC, and it allows for the detection of additional relevant findings, but cleansing efficiency could be improved.

Die Kolonkapselendoskopie (CCE) ist bei guter Vorbereitung eine verlässliche diagnostische Methode zur Detektion von Polypen im unteren Gastrointestinaltrakt. Allerdings ist die Auswertung der erzeugten Videos bislang sehr zeitaufwändig.

Z Gastroenterol 2016; 54 Mehr als 60 000 Neuerkrankungen und mehr als 25 000 Todesfälle pro Jahr sind in Deutschland dem Darmkrebs zuzuschreiben [1]. Zur Vorsorge und Früherkennung des kolorektalen Karzinoms gibt es wirksame Maßnahmen. Randomisierte Studien haben nachgewiesen, dass der Guajak fecal occult blood test (gFOBT) und die Sigmoidoskopie zu einer Senkung der KarzinomInzidenz und der Mortalität führen. Für die Koloskopie gibt es indirekte Evidenz aus Langzeit-Kohortenstudien, die eine ähnliche Wirkung nahelegen [2, 3]. Seit Einführung der Vorsorgekoloskopie 2002 in die Regelversorgung haben bisher nur rund 23 % der Anspruchsberechtigten an der FrüherkennungsKoloskopie teil genommen [4].

Die Koloskopie, Goldstandard für die Diagnostik kolorektaler Erkankungen, kann z.B. aufgrund von Schlingenbildung, Elongation, Entzündung oder Sedierungsproblemen inkomplett bleiben. PillCam Colon1 wurde zur Komplettierung inkompletter Koloskopien verwendet. Darmreinigung mit einer reduzierten Dosis (z.B. 2 × 1 L Moviprep) ist bereits als effektiv für die Kapsel-Koloskopie beschrieben worden. In dieser Studie sollen Vorteile und Limitationen einer Kapsel-Koloskopie nach inkompletter Koloskopie mit der weiterentwickelten PillCam Colon2 und low-volume Lavage eruiert werden.

Sämtliche Literatur-Angaben bei der Fachgruppe Kapselendoskopie auf der Webseite des bng. 2. Kolon ▼ Die Kolon-Kapsel-Endoskopie ist eine ambulante Untersuchungsmethode zur Visualisierung des gesamten Gastrointestinaltrakts, im Besonderen des Kolons. Sie kann eingesetzt werden, wenn die konventionelle Video-Koloskopie unvollständig ist, als zu risikoreich erscheint oder vom Patienten abgelehnt wird.

Die Autoren begrüßen ausdrücklich das Modell-Projekt der AOK Bayern zur Versorgungsrealität bezüglich der regionalen Darmkrebsvorsorge.

Colonoscopy is the gold standard for colorectal diseases but may be incomplete e.g. in redundant colon, severe inflammation or intolerance to sedation. PillCam Colon1 has been used to complement colonoscopy, low volume lavage (2 x 1 liter Moviprep) has been reported effective for colon capsule endoscopy (CCE). We report data from a prospective multi-center study using CCE with PillCam Colon2 after incomplete colonoscopy. Primary endpoint of this study was the ability of CCE to complement incomplete colonoscopy. Secondary endpoint were cleansing levels after low volume lavage and additional findings with CCE including polyp detection. Patients with incomplete colonoscopy performed by an experienced gastroenterologist and without stenosis were included. CCE was performed either on the day after colonoscopy with additional Moviprep lavage in the morning. Alternatively, CCE was performed within 30 days using new bowel cleansing (Clear liquids day before + split-dose Moviprep). Additional boosts consisted of 0.75 or 0.25 l Moviprep and NaP only as additional rescue boost if capsule was not excreted after 9 hours. According to other studies significant polyps were defined by size (≥ 6 mm) or number (≥ 3). 81 patients were enrolled, 7 patients were excluded due to technical failure (n=1) or non-compliance to preparation protocol (n=6). Finally data of 74 patients (44 female, 30 male, median age 67 years) could be analyzed. CCE visualized missing colonic segments in 95% while complete CCE was achieved in 65%. An additional intention-to-treat analysis of all 81 patients showed a completion rate of 63% and a complementation rate of 91%. In 36/74 patients (49%) polyps were detected, and significant polyps in 28% of all patients, respectively. In 27 of the 36 patients with polyps (75%) the polyps were located in segments not reached by colonoscopy. In one case an adenocarcinoma was diagnosed after detection of a 26 mm cecal polyp. Other findings like erosions or diverticula were seen in 76%. One capsule was retained temporarily in the small bowel. Surgical resection lead to the previously unknown diagnosis of stenosing and fistulating Crohn`s disease. Cleansing levels were adequate in 65% in CCE and in 68% in standard colonoscopy. In our study complementation of incomplete colonoscopy with PillCam Colon2 and Moviprep regimen was in concordance with previous data for PillCam Colon1 and for device assisted colonoscopy, also showing a relevant amount of additional findings. Complementation rates of CCE were high. CCE and colonoscopy had similarly moderate cleansing levels, probably caused by unfavourable anatomy. Nevertheless, CCE showed a high diagnostic yield. Slow transit due to functional stenosis or motility disorder may be a risk factor for incomplete CCE. In conclusion CCE seems to be a safe and beneficial tool after incomplete colonoscopy.

Background and study aims: Colon capsule endoscopy (CCE) offers an alternative approach for endoscopic visualization of the colon. Some of the current CCE bowel cleansing regimens use sodium phosphate, which has raised safety concerns. Therefore, the aim of the current study was to test the feasibility and efficacy of a new low-volume, sodium phosphate-free polyethylene glycol (PEG) bowel preparation.Methods: The first 26 patients (original cleansing procedure) received a colon cleansing regimen of PEG plus ascorbic acid: patients drank 1L in the evening and 0.75 L in the morning before capsule ingestion. Patients also drank an additional 0.5 L PEG boost and an optional 0.25 L PEG boost during the capsule procedure. Following an interim analysis, the cleansing procedure of the subsequent 24 patients was modified, with the morning intake before capsule ingestion being increased to 1L, as well as the second boost (0.25 L) being administered 1-2 hours earlier (modified cleansing procedure).Results: The overall colon cleanliness was considered to be good or excellent in 83% (original cleansing procedure) and 82% (modified cleansing procedure) of patients, without any significant difference between regimens (P > 0.05). In 37/49 (76%) of the CCE procedures, the hemorrhoidal plexus was identified and thus the examination was considered complete, with no significant differences between the two CCE cleansing procedures. The capsule sensitivity and specificity for detecting colonic polyps >= 6mm were 91% (95% CI 70%-98%) and 94% (95% CI 87%-97%), respectively, compared with standard optical colonoscopy.Conclusion: A colon cleansing procedure using PEG + ascorbic acid for capsule colonoscopy yielded an adequate cleansing level in >80% of patients, a completion rate of 76%, and good accuracy for detecting polyps. This procedure may be considered as an alternative, particularly for patients in whom sodium phosphate-based preparations are contraindicated.

Duodenal adenomas (DA) are diagnosed in surveillance programs of FAP and they can be infrequently detected as sporadic lesions during routine EGD. There are only few data on EMR of DA as a minimally invasive alternative to surgery.

I read with great interest the recent studies of Fernandez-Esparrach [1] and Philipper [2] on diagnosing gastrointestinal stromal tumors (GIST). I agree with their observations that endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is often hampered by the lack of sufficient tissue to allow histology and immunohistochemistry to be done and that Tru-cut biopsy is technically impossible when the endoscope is angulated. I suggest a much simpler and more efficient method that uses an EUS-guided keyhole biopsy technique (EUS-KB). Four patients (mean age 68 years) with submucosal tumors had experienced unsuccessful attempts at tissue diagnosis by conventional upper endoscopic forceps biopsy and underwent EUS-KB. The anatomic sites of the lesions were the stomach (n = 2) and the duodenum (n = 2). Following EUS evaluation of the submucosal lesion, a needle knife was used to cut a small mucosal keyhole over the center of the lesion (●" Fig. 1 a). A biopsy forceps was then introduced through the hole into the center of the lesion and multiple samples were obtained and placed in formalin (●" Fig. 1 b). The mean procedure time was 31 minutes. There were no complications. Adequate specimens for histology, mitotic rate, and immunohistochemistry were obtained from all lesions, allowing a diagnosis in all patients. The tissue specimens measured 7–10mm and showed no cautery artifacts. Pathology showed one benign lesion (fibroma) and three neoplastic lesions (two GIST, one gastrinoma). Surgical resection was performed in two patients and confirmed the EUS-KB diagnosis of GIST and gastrinoma. Therefore, EUS-KB may represent an easy and quick technique providing abundant histological tissue to accurately diagnose mesenchymal tumors.

We greatly appreciate the conclusive technique called the endoscopic ultrasonography (EUS) keyhole biopsy technique proposed by Peter Grubel. Facing the situation of suboptimal EUS-guided fine needle aspirates, as we have shown in our series with a miss rate of up to 40 % for the additional immunocytochemical analysis, new techniques are crucial to overcome this situation.

The successful application of the small bowel capsules opened new fields for technical innovations of these systems for the whole GI tract. New developments in this field are the second generation esophageal capsule (Pillcam (R) Eso 2) and colon capsule (Pillcam Colon 2). Although the collection of data for the new systems just started, the already available publications demonstrate that technical progress may increase the accuracy of these systems. Further innovations like the implementation of the Fujinon FICE system or a via a magnetic system steerable capsule for the upper GI tract may enhance the use in the daily clinical routine.

BackgroundAn ingestible capsule consisting of an endoscope equipped with a video camera at both ends was designed to explore the colon. This study compared capsule endoscopy with optical colonoscopy for the detection of colorectal polyps and cancer.MethodsWe performed a prospective, multicenter study comparing capsule endoscopy with optical colonoscopy (the standard for comparison) in a cohort of patients with known or suspected colonic disease for the detection of colorectal polyps or cancer. Patients underwent an adapted colon preparation, and colon cleanliness was graded from poor to excellent. We computed the sensitivity and specificity of capsule endoscopy for polyps, advanced adenoma, and cancer.ResultsA total of 328 patients (mean age, 58.6 years) were included in the study. The capsule was excreted within 10 hours after ingestion and before the end of the lifetime of the battery in 92.8% of the patients. The sensitivity and specificity of capsule endoscopy for detecting polyps that were 6 mm in size or bigger were 64% (95% confidence interval [CI], 59 to 72) and 84% (95% CI, 81 to 87), respectively, and for detecting advanced adenoma, the sensitivity and specificity were 73% (95% CI, 61 to 83) and 79% (95% CI, 77 to 81), respectively. Of 19 cancers detected by colonoscopy, 14 were detected by capsule endoscopy (sensitivity, 74%; 95% CI, 52 to 88). For all lesions, the sensitivity of capsule endoscopy was higher in patients with good or excellent colon cleanliness than in those with fair or poor colon cleanliness. Mild-to-moderate adverse events were reported in 26 patients (7.9%) and were mostly related to the colon preparation.ConclusionsThe use of capsule endoscopy of the colon allows visualization of the colonic mucosa in most patients, but its sensitivity for detecting colonic lesions is low as compared with the use of optical colonoscopy. (ClinicalTrials.gov number, NCT00604162.)

Einleitung: Die PillCam® Colon hat ein hohes Potential in Zukunft die Angebotspalette in der Darmkrebsvorsorge zu erweitern. Um den Darm für die Untersuchung adäquat zu reinigen und eine komplette Darstellung des Dickdarms zu erreichen ist bisher eine umfangreiche Vorbereitung unter dem Einsatz mehrerer Medikamente notwendig.