Colon capsule endoscopy (CCE) has regained popularity for lower gastrointestinal investigations since the COVID-19 pandemic. While there have been systematic reviews and meta-analyses on colonic polyp detection using CCE, there is a lack of comprehensive evidence concerning colonic inflammation. Therefore, this systematic review and meta-analysis aimed to assess the diagnostic accuracy of CCE for colonic inflammation, predominantly ulcerative colitis (UC) and Crohn’s disease (CD). Methods: We systematically searched electronic databases (EMBASE, MEDLINE, PubMed Central, and Cochrane Library) for studies comparing the diagnostic accuracy between CCE and optical endoscopy as the standard reference. A bivariate random effect model was used for the meta-analysis. Results: From 3797 publications, 23 studies involving 1353 patients were included. Nine studies focused on UC, and ten focused on CD. For UC, CCE showed a pooled sensitivity of 92% (95% CI, 88–95%), a specificity of 71% (95% CI, 35–92%), and an AUC of 0.93 (95% CI, 0.89–0.97). For CD, the pooled sensitivity was 92% (95% CI, 89–95%), and the specificity was 88% (95% CI, 84–92%), with an AUC of 0.87 (95% CI, 0.76–0.98). Overall, for inflammatory bowel disease, the pooled sensitivity, specificity, and AUC were 90% (95% CI, 85–93%), 76% (95% CI, 56–90%), and 0.92 (95% CI, 0.94–0.97), respectively. Conclusions: Despite the challenges around standardised disease scoring and the lack of histological confirmation, CCE performs well in diagnosing inflammatory bowel disease. It demonstrates high sensitivity in both UC and Crohn’s terminal ileitis and colitis and high specificity in Crohn’s disease. Further studies are needed to evaluate the diagnostic accuracy of other colonic inflammatory conditions.

Background: Capsule endoscopy (CE) is safe and widely accepted for small bowel (SB) investigation and an alternative to colonoscopy in specific clinical circumstances. As the capsule is orally ingested, the potential risk of aspiration is undoubtedly a constant concern among clinicians. However, it is a rare occurrence and often reported as isolated cases. Therefore, this review systematically compiles all the available data on capsule aspiration in the literature with an aim to provide an update on this complication of CE. Methods: A systematic literature search was performed on PubMed with the search terms ‘capsule endoscopy’ AND ‘aspiration’, searched as keywords and MeSH. All observational cohort studies that reported aspiration among complications/outcomes, case reports and series on capsule aspiration were included. Manual citation search was performed. Two extractors reviewed abstract and full-text and performed data extraction. Results: We found 95 relevant articles, and cross-checking references led to the inclusion of an additional 19 articles. We removed 57 and ended with 57 references—with 63 cases of aspirated capsules. One death was reported. The median age was 78, and there was male preponderance. The most common indication for CE was anaemia, and only aspiration of small bowel CE (SBCE) was reported. 61.9% of the aspirations were symptomatic; the most common symptom was coughing. 69.8% of capsules ended in the bronchus, but only 4 cases experienced desaturation. Thirty-two patients needed intervention for retrieval; the aspiration was self-resolved in the remaining. Only four patients had a history of dysphagia. Thirteen instances of aspiration were detected due to real-time viewing, and 24 cases from reviewing the capsule data afterwards. Conclusions: With only 63 cases of aspirated capsules reported in the literature, this event remains rare, is safely managed, and should not discourage patients from the procedure. The importance of careful patient selection is crucial to minimize the likelihood of aspiration and capsule administration should be approached with precautions.

Background and study aims This review aimed to provide an updated and comprehensive review of capsule retention within diverticula, shedding light on the characteristics and management of this rare event in capsule endoscopy. Methods A systematic literature search was conducted across multiple databases. All observational studies that reported capsule retention in a diverticulum among complication and outcomes, as well as case reports and series, were included. Manual cross-checking of references was also performed. Two extractors performed abstract and full-text reviews, as well as data-extraction. Results We found 167 references from Pubmed, Embase, and Web Of Science. Sixty-five duplicates were removed and another 71 references were excluded. Crosschecking of references found additional two articles. In total, 32 articles were included, resulting in a total of 34 cases of retained capsules in diverticula. The median age was 69 and the majority of the patients were male (76.5%). The most common retention occurred in Meckel’s diverticulum (32.4%) followed by Zenker’s diverticulum (20.6%). Investigation of capsule retention was done with x-ray (50%) and computed tomography (CT) scan (44.1%). Seventeen cases (50%) were asymptomatic. Resolution of the retention happened with endoscopy (35.3%) and surgical management (32.4%), as well as self-resolution (20.6%). Conclusions Due to the small number of cases, diverticula are not a risk factor for incomplete capsule endoscopy examination. It affects mainly elderly, male, asymptomatic patients, and typically is diagnosed with x-rays and CT scans. The most common type is Meckel’s diverticulum, and endoscopy is the primary management. Capsule endoscopy retentions are extremely rare, with only 34 cases reported since the technology's introduction.

In the Danish health care system, follow-up colonoscopy is standard after a colonic diverticulitis episode in order to exclude malignancy. Colon capsule endoscopy (CCE) is a diagnostic alternative to colonoscopy. This study compared patient-reported outcomes of CCE versus colonoscopy after diverticulitis episodes. A randomized controlled trial was conducted in patients with computed tomography-verified diverticulitis from Odense University Hospital. Patients were randomized to either CCE or colonoscopy 4–6 weeks after discharge. The primary outcome was patient-reported experienced physical and mental discomfort related to the procedures. Secondary outcomes were expected physical and mental discomfort, examination preference, proportion of complete examinations, and frequency of polyps and colorectal cancer. 159 patients were randomized, with 148 receiving their allocated intervention and 83 completing the questionnaires. Demographic data were comparable between the two groups. No adverse events were observed. Patients expected greater physical and mental discomfort with colonoscopy than with CCE. However, no significant difference was found in experienced physical and mental discomfort between CCE and colonoscopy. For hypothetical future events, 49% of patients would prefer CCE, 13% would prefer colonoscopy, and 38% did not know. Complete examinations were reported for 84% of CCEs and 92% of colonoscopies. No malignant lesions were found. CCE was a safe follow-up procedure after a diverticulitis episode. CCE was preferred to colonoscopy by most patients who reported their experience. No difference was observed regarding experienced physical and mental discomfort between the groups completing the questionnaires.

The gastrointestinal (GI) tract, particularly the small bowel (SB), can be challenging for novel investigation tools

Background: Little is known about the involvement of gut microbiota in the disease course of diverticulitis and the potential benefits of manipulating the gut milieu. We propose to conduct a randomised placebo-controlled feasibility trial of faecal microbiota transplantation (FMT) given as capsules to patients with acute uncomplicated diverticulitis. Objectives: The objective is primarily to investigate the feasibility of clinical safety, explore efficacy associated with FMT in this patient population, and examine changes in patient-reported quality of life and the composition and function of the gut microbiota. Design: Study protocol for a randomised placebo-controlled trial. Methods and analysis: Participants with acute, uncomplicated diverticulitis, as confirmed by computed tomography (CT) scan, will be recruited from Odense University Hospital (Denmark) and randomly assigned to either the intervention group or the control group. The intervention group will consist of 20 patients who receive encapsulated FMT. The control group will also consist of 20 patients, receiving placebo capsules. Primary safety endpoint: Patient safety is monitored by (a) the number of re-admissions and (b) the number of adverse events within 3 months of FMT/placebo; Primary efficacy endpoint: Reduction in the proportion of patients treated with antibiotics within 3 months following FMT/placebo; Secondary outcome: Change from baseline to 3 months in the GI-QLI questionnaire. Results will be analysed using an intention-to-treat approach. Adverse events or unintended consequences will be reported. Ethics and discussion: This is the first study to investigate the safety and efficacy of FMT in patients with acute uncomplicated diverticulitis. The project has the potential to broaden the knowledge and literature on the role of the intestinal microbiota in diverticulitis, and we believe it will elevate our understanding of cause and effect. Trial registration: Informed consent is obtained from all participants. The study is approved by the regional ethics committee (ref. S-20230023) and the Danish Data Protection Agency (ref. 24/2435). The trial was registered on clinicaltrials.gov (NCT06254625) on 10th February 2024.