A prospective, single-center, single-arm, non-randomized, post-market pilot study evaluating the technical feasibility of mucosal staining during COLON2 Capsule Endoscopy (CCE) procedure in population at high risk for Colorectal Cancer (CRC), when using MB-MMX (Methylene Blue).

Up to 15 subjects will be enrolled in 1 center located in Spain. Study duration- up to 10 months from study approval.

Single-center, prospective, non-randomized clinical trial designed to evaluate the technical feasibility during CCE procedure, when using MB-MMX as a contrast- enhancement technique of mucosal staining in CRC high risk population.

Subjects will undergo a bowel preparation (single dose, 4L PEG), including 200 mg Methylthioninium chloride, corresponding to eight 25 mg MB-MMX tablets and 1 tab of Resolor (Prucalopride 1mg). An experienced Gastroenterologist will read the CCE procedure and complete a subjective questionnaire, to evaluate mucosal enhancement during a CCE procedure, when using MB-MMX as a contrast-enhancement technique.

Inclusion Criteria:

1. Male or female adults ages 45-75 years

2. Subject is classified as being at high risk for CRC due to one (or more) of the following risk factors:

   • A personal history of colorectal polyps
   • A first-degree family history of colorectal cancer
   • Family/personal inherited syndrome (Lynch syndrome, Familial adenomatous polyposis {FAP}, other inherited syndromes linked to colorectal cancer)
   • Subject with currently suspected or diagnosed rectal bleeding, including positive FIT or positive fecal DNA test
   • Subjects under surveillance for CRC (last OC≥1.5 years)

3. Subject is willing and able to participate in study procedures, understand and sign the informed consent

Exclusion Criteria:

1. Subject has a previous history or suspicion of inflammatory bowel or Crohn's disease, ulcerative Colitis or indeterminant Colitis

2. Subject has congestive heart failure or recent myocardial infarction (<3month)

3. Subject with moderate/severe renal disease and/ or severe hepatic impairment

4. Subject has uncontrolled diabetes

5. Subject has a severe, life-threatening disease

6. Subject with known gastrointestinal motility disorders

7. Subject has known delayed gastric emptying

8. Subject has undergone surgery of the luminal gastrointestinal (GI) tract, from esophagus to the rectum, other than uncomplicated appendectomy or cholecystectomy.

9. Subject with any current condition believed to have an increased risk of capsule retention such as suspected or known bowel obstruction or pseudo-obstruction, stricture, or fistula (symptoms such as severe abdominal pain with accompanying nausea or vomiting)

10. Subject with dysphagia, any swallowing disorder, or any major gastrointestinal motility disorder

11. Subject has a history of inadequate bowel preparation for colon imaging with colonoscopy, CTC, CCE, or DCBE (self-reporting)

12. Subject with known or suspected constipation history as defined by the following: as needing the use of medication (prescription or OTC) for management of constipation, or fewer than 3 BM/week regardless of medication use

13. Subject with a cardiac pacemaker or other implanted electromedical device

14. Subject with planned MRI examination within 7 days after ingestion of the capsule

15. The subject is taking antidepressant medicine or a medicine for psychiatric illness, such as:

    • selective serotonin reuptake inhibitor (SSRI)- as fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, escitalopram and zimeldine; bupropion, venlafaxine, mirtazapine, clomipramine, buspirone
    • medicines classified as Monamine Oxidase Inhibitors (often used for treating depression).

16. Subject has glucose-6-phosphate dehydrogenase (G6PD) deficiency and/or allergic to peanut/soya

17. Subject consumes any of the medicinal products which interacts with MB-MMX, as per MB-MMX label and Investigator's discretion.

18. Subject with allergies or known contraindication to the device, medications or preparation agents used in the procedure as described in the relevant instructions for use/package inserts.

19. Subject use of opioid medication on a regular basis and requires medication to treat opioid induced constipation

20. Subject currently participating in another gastrointestinal clinical study (investigational drug or device) that might interfere with results of study

21. Females who are pregnant or breastfeeding at time of bowel prep

22. Any condition which precludes compliance with study and/or device instructions based on the clinical judgment of the investigator

23. Subject who is considered to be part of a vulnerable population (e.g. prisoners or those without sufficient mental capacity)

24. Medtronic employees