Colon CE (CCE) was first reported in 2006 [10]. The first generation CCE (CCE-1) has some technical differences from the small-bowel capsule: it is approximately 6 mm longer; it has dual cameras that enable the device to acquire video images from both ends, and a frame rate of four frames per second. Currently, CCE has been mainly used for colorectal cancer screening. CCE-1 had moderate sensitivity for surveillance of colorectal neoplasia [11]. To obtain higher sensitivity, second-generation CCE (CCE-2) (PillCam COLON 2^®, Covidien Co. Ltd., Yokneam, Israel) was developed [12]. CCE-2 is equipped with a high frame rate camera which can take 4–35 pictures per second when the capsule is accelerated by peristalsis. The colon CE system (CCE-2 and data recorder) is shown in Fig. 4.2. CCE-2 and data recorder can communicate bi-directionally. The data recorder can receive the information of the transit speed of the capsule, and control the image capture rate. CCE-2 has demonstrated a high sensitivity for the detection of clinically relevant polypoid lesions [13]. A CCE procedure requires a large amount of and multi-step preparation for colon cleansing and the capsule booster [14]. This large amount of preparation might reduce patient acceptance and preference.

Efficacy of CCE on IBD has not been still unconfirmed. With regard to Crohn’s disease, only one case series using CCE was reported [15]. The main target disease among IBD for CCE is considered to be ulcerative colitis (UC). Hong Kong’s group reported that CCE-1 was a safe procedure to monitor mucosal healing in UC; however, CCE could not be recommended to replace conventional colonoscopy [16]. On the other hand, we have reported that CCE-2 was able to assess the severity of mucosal inflammation in patients with UC [17]. We also created a new reduced bowel preparation regimen for UC in order to obtain high patient acceptance [18]. The current modified bowel preparation regimen for UC is shown in Table 4.1. Patients took a maximum 2.8 l of lavage solution (PEG and magnesium citrate) in two or three divided doses. Even using conventional colonoscopy, UC-associated colorectal cancer is not readily detectable. UC-associated colorectal cancer could not be evaluated by CCE-2 from our experience. The indications for CCE-2 for UC are thus limited to assessments of the severity of inflammation in UC.

Colon capsule endoscopic images of UC are shown in Figs. 4.3 and 4.4. Figure 4.3a shows colon capsule endoscopic image of inflammatory benign polyps in the ascending colon. Mucosal healing can be judged from the colon capsule image. Figure 4.3b shows same lesion observed by conventional colonoscopy. Figure 4.3a seems to be identical with Fig. 4.3b. A geographical ulcer with white exudate and inflammatory edematous mucosa was clearly observed by CCE-2 in active UC (Fig. 4.4a). Figure 4.4b shows the same lesion observed by conventional colonoscopy, identical with Fig. 4.4a.