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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.
Debate exists regarding the number of species of the moon jellyfish (genus Aurelia), a common member of the planktonic community of the coastal shelf seas around the world. Three Aurelia congeners (A. aurita, A. labiata and A. limbata) are currently considered to exist but recent genetic analyses suggested that this is an oversimplification. We analyzed the morphological characteristics of scyphistomae, morphological characteristics of ephyrae and differences in the time span of the strobilation process of Aurelia congeners from 17, 7 and 6 different source populations, respectively, of known species. Morphological characteristics of scyphistomae were similar among the 17 populations but those of ephyrae, such as the shape and form of lappets, were effective discriminators in the 6 cases examined. We recommend identifying species based on differences in 1) the morphological characteristics of scyphistomae and ephyrae (and not only medusae), 2) the genetics of individuals, and 3) the geographical occurrence of the population. This study adds to the growing body of knowledge on scyphozoan scyphistomae and ephyrae, stages of the metagenic life cycle of scyphozoans that have received relatively little study compared to medusae.