Pan-intestinal Capsule Endoscopy (PIC) offers a potential to assess the entire small bowel and colon in a single test. PIC may be advantageous in a variety of clinical scenarios, including the established indication of Crohn’s disease assessment and the more recently proposed indication of suspected mid-lower GI bleeding and for selected patients with polyposis syndromes. Its uptake and efficacy in routine clinical practice remain to be assessed.

PIC procedural data uploaded to the Irish Capsule Endoscopy Registry (ICaRe) from 2024 to date were included for analysis. Patient demographics, clinical indication, and procedural variables – including bowel preparation and booster regimen, capsule type, complete transit rate (capsule reaching the dentate line), adequate image quality, complete study rate (transit and image quality) and significant small bowel or colonic findings – were documented.

In all, 307 PIC procedures were included in the registry. The median age was 57 years (IQR 40–71), and 134 (44%) were male. A dedicated PIC capsule was used in only 32 (10%) of cases, with the remainder employing colon capsules. The indication given for PIC was obscure GI bleeding in 48% (n = 146), Crohn’s disease assessment in 16% (n = 49), new GI symptoms in 10% (n = 32), screening in 6% (n = 19), polyp surveillance in 4% (n = 12), incomplete colonoscopy in 4% (n = 13), and other indications in 8% (n = 36). The complete transit rate was 78% (n = 240) and adequate image quality in both the small bowel and colon was reported in 76% (n = 234). The combined complete study rate (transit and adequate image quality) was 65% (n = 198). While the overall diagnostic yield was 47% (n = 145), significant colonic findings (CRC, significant polyps, or colitis) were found in 25% (n = 76), including two with colorectal cancer. While significant small bowel disease was found in 26% (n = 81), indication did not affect diagnostic yield. Of interest, PIC performance varied by preparation and booster regimen. Higher complete transit rates were seen in subjects who received low-dose PEG-based bowel preparation with Plenvu, 100% vs 75.6% (OR 23.7; 95% CI 1.4–392.1; p < 0.001). Patients who received higher-volume PEG (2 litres of Moviprep), compared with other bowel preparation regimens, were more likely to have inadequate image quality (OR 0.37; 95% CI 0.17–0.82; p = 0.014). Of note, prucalopride as a booster had no impact on either transit or complete study rate, while the use of castor oil as a booster was significantly associated with a higher complete study rate, 55% vs 75% (OR 2.4; 95% CI 1.5–3.9; p < 0.001). Although transit rates were similar (28/32 [88%] vs 212/275 [77%]), both adequate image quality and resultant complete study rates were higher with dedicated PIC Crohn’s capsules compared with colon capsules. Adequate image quality was achieved in 29/32 (91%) vs 205/275 (75%) (OR 0.30; 95% CI 0.09–1.03; p = 0.05), and complete studies were achieved in 28/32 (88%) vs 172/275 (63%) (OR 0.24; 95% CI 0.08–0.67; p = 0.009). However, patients in the Crohn’s capsule cohort were significantly younger, which may have affected outcomes (p = 0.03).

Our clinical data suggests PIC is being employed in a variety of clinical scenarios, with variable procedural success. Despite this, the overall diagnostic yield for both colonic and small bowel disease was high, irrespective of indication. PIC procedures should be considered as a distinct capsule entity, with specific procedural recommendations, as variations in bowel preparation, boosters and capsule type all impact performance.