New Screening Tool: PillCam COLON

by gastroenterologist and Fight Colorectal Cancer board member Indran Indrakrishnan M.D. 

PillCam® COLON  is a new technology to evaluate the colon for polyps. The FDA recently gave clearance for the PillCam® COLON to be used in patients following an incomplete colonoscopy. Read more here.

The basic concept of capsule endoscopy has been in practice for nearly 10 years for evaluating the small bowel. The PillCam® COLON relies on a thorough, high-quality bowel preparation for accuracy, just like colonoscopy, and serves as a new screening tool complementary to a colonoscopy.

Uses of the New Technology

This new technology will be particularly useful for:

1. Patients who are not willing to undergo an invasive procedure

2. The occasional case of a difficult colonoscopy that prevents a complete examination of the colon

3. Patients who are high risk for anesthesia and (minimally invasive ) colonoscopy.


Colonoscopy vs. PillCam® COLON

pillcam-colon-screeningRecent studies showed that the sensitivity and specificity of PillCam® COLON  for detecting polyps and cancer are reasonably good, but colonoscopy remains the gold standard for colon cancer prevention: the detection and removal of polyps that interrupts the polyp-to-cancer process.

PillCam® is a low-risk procedure. People are becoming increasingly concerned with the risks of radiation associated with radiological studies and virtual colonoscopy has this risk, but PillCam® does not involve radiation.

Resolution with capsule endoscopy is excellent, but there is also a learning curve involved in interpreting the examinations. Colonoscopy occurs in real-time, but the results of PillCam® COLON will be reviewed after it has passed through the colon.

The cost of PillCam® COLON is less than colonoscopy and it does not cause pain nor require any anesthesia. However  if a polyp/cancer/lesion is found by PillCam® COLON, then colonoscopy is necessary to remove/biopsy which adds to the cost in addition to the repeat bowel prep and extra time.

Potential Side Effects

One side effect is that the capsule may get stuck in the small bowel or colon within a high grade stricture, and in this case the patient would require surgery to remove the pill. PillCam should not be used if the patient is known to have stricture in the small or large bowel.

I have been using capsule endoscopy for the evaluation of the small intestine for many years and I love this technology. PillCam® COLON is similar but there were some technical barriers which needed to be sorted out before it becomes available to detect colon polyps and cancers.

Dr. Indrakrishnan’s Thoughts

It is important to consider whether or not the sensitivity is sufficient to use PillCam® COLON as a primary screening tool. Issues of sensitivity, specificity and patient acceptability are subjective to a certain extent.

Also, there is a definite measurable rate of false positives associated with PillCam® COLON.

As of now, I would recommend PillCam® COLON to selected patients on a case-by-case basis and not to all comers. I support new screening technologies and hope to see the screening rate increase.


Read about your Screening Options for Colon and Rectal Cancer

Learn the Signs & Symptoms of Colon Cancer


Disclosure: Fight Colorectal Cancer has accepted funding for projects and educational programs from Given Imaging, producers of the PillCam® COLON, in the form of unrestricted educational grants. Fight Colorectal Cancer has ultimate authority over website content.