Colon capsule endoscopy for colonic surveillance

Abstract

Aim Resources used in surveillance colonoscopies are taking up an increasing proportion of colonoscopy capacity. Colon capsule endoscopy (CCE) is a promising technique for noninvasive investigation of the colon. We aimed to investigate CCE as a possible filter in colonic surveillance with the primary outcome of reducing the number of colonoscopies.Method Patients scheduled for follow-up colonoscopy were subjected to a primary CCE and only supplemental conventional endoscopy if significant pathology was detected or if the CCE examination was incomplete. Significant pathology was defined as more than two small polyps, or one polyp greater than 9 mm or any polyp in patients with hereditary nonpolyposis colorectal cancer. Supplemental endoscopy was carried out to the extent needed to resect the detected polyps and investigate the parts of the colon that were not sufficiently visualized by the capsule.Results A total of 180 patients were included. Seventyseven patients (43%) had a complete CCE with no significant findings. A complete colonoscopy was carried out in 67 patients (37%) and 36 patients (20%) underwent a sigmoidoscopy. In the 103 patients undergoing endoscopy, 59 (57%) had no adenomas detected, 33 (32%) had 'low-risk' adenomas and 11 (11%) had 'high-risk' adenomas.Conclusion The introduction of CCE as filter test in colonic surveillance reduced colonoscopies by 43%, but this implies that untreated polyps are left behind and is not cost-effective. The CCE completion rate must be improved.What does this paper add to the literature? This is the first study to date to investigate the potential of colon capsule endoscopy as a filter test for colonoscopy in colonic surveillance. We found that it reduced the number of colonoscopies by 43%, but it requires that small polyps are left untreated; colon capsule completion rates must be improved.

Colon capsule endoscopy: an innovative method for detecting colorectal pathology during the COVID‐19 pandemic?

“…In all concurrent validity studies comparing CCE to colonoscopy, it has detected all colorectal cancers (100% sensitivity/specificity). A recent Danish surveillance study has used CCE as a filter to colonoscopy and demonstrated a reduction in the number of colonoscopies required [16]. Given CCE’s high sensitivity for detection of pathology, we suggest its use as a triaging tool, particularly when pressure on endoscopy units is likely to be high.…”

Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline – Update 2020

“…The accuracy of CCE in post-polypectomy surveillance has not been carefully investigated. Only one study investigated CCE as a possible filter test in colonic surveillance in patients scheduled for follow-up colonoscopy [100]. In this study, 102 of 180 patients (57 %) who underwent CCE also underwent a supplemental colonoscopy, because either significant pathology was detected on CCE or CCE examination was incomplete.…”

“…Consequently, post-CCE colonoscopy referral of these patients may be expected to lead to a substantial reduction of the prevalence of advanced neoplasia in patients initially evaluated with CCE. Using a cutoff of significant findings defined as no more than 2 polyps of 10 mm, 43 % of patients have avoided colonoscopy; however, high risk findings were detected in only 10.7 % of patients who underwent colonoscopy [100]. This approach entails that small polyps will be left untreated until the subsequent follow-up.…”

Feature Point Tracking-Based Localization of Colon Capsule Endoscope

“…More precisely, this study proposes a model that can identify the two flexures, ascending-, transverse-, and descending-colon parts of the large intestine. In many cases, polyp identified by CCE is not found in the succeeding colonoscopy [ 13 , 14 ], and, thus, such information is of clinical importance to the physicians, as it narrows down the location of the disease, reducing the time and ambiguity of following therapeutic endoscopies and increased chance of successful identification of polyps.…”