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Tsuboi et al. Mini-invasive Surg 2024;8:26 https://dx.doi.org/10.20517/2574-1225.2023.94 Page 7 of 21

while both devices are effective for lesion detection, PillCam may offer advantages in terms of efficiency.
TM
TM
PillCam vs. OMOM
TM
A single study comparing PillCam SB3 with OMOM2 found no significant difference in the diagnostic
rates for detecting bleeding sources (88.6% for PillCam vs. 77.3% for OMOM2) . These findings suggest
TM
[73]
that both devices can be effectively used for detecting small-bowel bleeding.
MiroCam® vs. Endocapsule
In a study comparing MiroCam® and Endocapsule, no statistically significant difference was observed in the
diagnostic yields of the two devices (50% for MiroCam® vs. 48% for Endocapsule) . These results suggest
[74]
that both modalities offer comparable diagnostic capabilities.

Meta-analysis of each modality
A recent meta-analysis of these studies concluded that there are no significant differences in the diagnostic
[75]
performance of the various SBCE modalities . However, it is important to note that many of these studies
involved older SBCE models, particularly as newer generations of SBCE devices, such as PillCam SB3,
TM
TM
continue to evolve. In fact, some studies have indicated that PillCam SB3 exhibits a higher diagnostic
ability for small-bowel and esophageal lesions than PillCam SB2 [59,76] . Consequently, future comparative
TM
studies of currently available CE devices are anticipated.
CURRENT STATUS OF CCE
First-generation CCE was developed in 2006 , followed by the second-generation CCE (CCE2) PillCam TM
[7]
Colon 2 (Medtronic, Minneapolis, MN, USA) in 2009 . Measuring 31.5 mm in length and 11.6 mm in
[77]
diameter, CCE2 employs two cameras and an AFR that automatically adjusts the frame rate from 4 to 35
FPS depending on the capsule’s movement speed. Endoscopic images of CCE2 are shown in Figure 3.
Although the CS remains the gold standard for colorectal cancer screening, CCE has emerged as a
promising alternative due to its minimally invasive nature and high patient acceptability. Meta-analyses
have reported that, when compared to CS, CCE-2 exhibits sensitivity and specificity of 87% and 95%,
respectively, for polyps larger than 10 mm, and 87% and 88%, respectively, for polyps larger than 6 mm [78-80] .
Computed tomography colonography (CTC) is an alternative to CS for colorectal cancer screening. In
comparison to CTC, CCE showed a better detection yield, particularly for diminutive colorectal polyps ≥ 6
mm [81,82] . González-Suárez et al. reported that the sensitivity and specificity for the neoplastic lesions ≥ 6 mm
of CCE were 96.1% and 88.2%, whereas that of CTC was 79.3% and 96.3%, respectively . Cash et al.
[81]
reported that the sensitivity and specificity of CCE for polyps ≥ 6 mm were 79.2% and 96.3%, while that of
CTC was 26.8% and 98.9%, respectively .
[82]

Many studies have reported the usefulness of CCE not only in diagnosing colorectal tumors but also in
evaluating colonic mucosal inflammation in ulcerative colitis [83-95] . In previous reports using CCE-1 for
ulcerative colitis, the diagnostic accuracy of CCE-1 was found to be insufficient. Consequently, these reports
concluded that CCE-1 is considered an inadequate alternative to CS [83-85] .

The first report on CCE-2 for ulcerative colitis was published in 2013 by Hosoe et al. Hosoe et al. reported
[86]
a high correlation (Ρ = 0.797) between CCE-2 and CS findings . The sensitivity, specificity, positive
[86]
predictive value, and negative predictive value of CCE-2 for assessing disease activity were reported to be
95 %-96 %, 100 %, 100 %, and 85% -92%, respectively, in previous reports [87,95] . Shi et al. also reported that
the measuring of Mayo endoscopic score (MES) and the Ulcerative Colitis Endoscopic Index of Severity
(UCEIS) derived from CCE-2 images correlated well with CS findings . However, there is concern that the
[92]