Proof of concept was achieved in 12 human cases (Gastroenterology 2006;130:672-7). The device reached the cecum in 10 patients in an average of 14 minutes. Only two patients required sedation, and no major mucosal damage was observed.
In two patients, the device stopped at the hepatic flexure, “so it's not perfect,” Dr. Pasricha said. The device “still requires insertion of a blunt instrument into the rectum. Some patients would object to that.”
The PillCam, a device made by Given Imaging Ltd., is a variation of the capsule endoscopy devices currently on the market. Its dual cameras cover twice as much area as most of the small bowel capsules do.
A pilot study of 91 patients found that the sensitivity of the PillCam was 56%-76%, and the specificity was 69%-100% (Endoscopy 2006;38:963-70). “We have a way to go with this technology,” Dr. Pasricha said. “But given its simplicity and the rate of innovation, this may well be the so-called magic bullet in the future.”
The PillCam is not currently approved for use in the United States.
Other solutions include products that decrease the duration without compromising the quality of care. These include NeoGuide Systems Inc.'s Navigator Endoscopy System, the ShapeLock endoscopic guide (USGI Medical), and the SoftScope (SoftScope Medical Technologies Inc.).
Devices that address the problem of missed polyps include the Third-Eye Retroscope (Avantis Medical Systems Inc.), cap-assisted colonoscopy, wide-angle colonoscopy, and bioendoscopic techniques such as chromoendoscopy.
“Clearly, at this point colonoscopy is still the gold standard, but I think this emerging technology is going to catch up in about 3-5 years,” Dr. Pasricha said.
'Colonoscopy is still the gold standard, but … this emerging technology [will] catch up in about 3-5 years.' DR. PASRICHA