Accuracy of Colon Capsule Endoscopy for Colorectal Neoplasia Detection in Individuals Referred for a Screening Colonoscopy

Abstract

Backround. Capsule colonoscopy might present an alternative to colonoscopy for colorectal neoplasia screening. Aim. To assess the accuracy of second-generation capsule colonoscopy (CCE2) for colorectal neoplasia detection compared with conventional colonoscopy (CC). Methods. From 2011–2015, we performed a multicenter, prospective, cross-over study evaluating the use of CCE2 as a possible colorectal cancer (CRC) screening test based on the assessment of the method’s characteristics (accuracy) and safety and patient acceptance of the routine. Enrolled participants fulfilled the CRC screening population criteria if they were asymptomatic, were older than 50, and had no personal or familial history of colorectal neoplasia. The primary outcome was accuracy for the detection of polyps≥6 mm. Secondary outcomes were accuracy for all polyps, polyps≥10 mm, adenomas≥10 mm, and cancers, the quality of bowel cleansing, safety, and CCE2 acceptability by the screening population. Results. A total of 236 individuals were examined; 11 patients (5%) were excluded. Therefore, 225 subjects (95%) were considered in the intention-to-screen (ITS) group. A total of 201 patients (89%) completed both examinations successfully (per protocol group). In the ITS group, polyps were diagnosed during CC in 114 subjects (51%); polyps≥6 mm, polyps≥10 mm, and adenomas≥10 mm were diagnosed in 34 (15%), 16 (7%), and 11 (5%) patients, respectively. The sensitivity of CCE2 for polyps≥6 mm, polyps≥10 mm, and adenomas≥10 mm was 79% (95% confidence interval (CI): 62–91%), 88% (95% CI: 62–98%), and 100% (95% CI: 72–100%), respectively. Conclusion. Second-generation capsule colonoscopy is a safe, noninvasive, and sensitive method for colorectal neoplasia detection although CC remains the preferred method for considerable proportion of subjects. CCE2 may therefore be accepted as the primary screening test for colorectal cancer screening.

Colon capsule endoscopy in colorectal cancer screening: a systematic review

“…The previously mentioned German study showed that the main reason for a final choice of CCE over colonoscopy was the fear of colonoscopy-related discomfort and complications [22]. With regard to patient preferences, one study showed that more participants preferred colonoscopy as the primary screening tool (53 %) compared with CCE (47 %) [18].…”

Diagnostic accuracy of capsule endoscopy compared with colonoscopy for polyp detection: systematic review and meta-analyses

“…The QUADAS-2 assessments of risk of bias and applicability concern are presented in ▶ Table 1. Six studies [13][14][15][16][17][18] had a low risk of bias in relation to patient selection, as either random or consecutive sample of patients were used. Two studies [19,20] were classified with high risk of bias in relation to the index test (CCE), as descriptions of the blinding process were insufficient.…”

“…The bowel preparation was related to mild adverse events such as vomiting and nausea in several patients [16-18, 20-23,25], with frequencies reaching 25 % [17]. The colonoscopy procedures were associated with few (14 of 1898 analyzed patients, 0.7 %) moderate to serious adverse events, such as bloating, abdominal pain, rectal bleeding, and bowel perforation, with some of those being related to the polyp removal procedure [15,16,18,22,23].…”

Frontiers of Robotic Colonoscopy: A Comprehensive Review of Robotic Colonoscopes and Technologies

“…Differently, the large intestine requires adequate distension for inspection and navigation that allows visual orientation. Therefore, WCE for the large bowel (PillCam TM Colon 1 and Colon 2—Medtronic Inc., Minneapolis, Minnesota, USA) inspection so far failed to show results competitive with conventional colonoscopies [ 62 , 63 , 64 ] ( Figure 2 E). Of note, lumen preparation is still necessary for the usage of WCE.…”