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

Abstract

Main recommendations 1 ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia.Strong recommendation, high quality evidence.ESGE/ESGAR do not recommend barium enema in this setting.Strong recommendation, high quality evidence. 2 ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. The timing depends on an interdisciplinary decision including endoscopic and radiological factors.Strong recommendation, low quality evidence.ESGE/ESGAR suggests that, in centers with expertise in and availability of colon capsule endoscopy (CCE), CCE preferably the same or the next day may be considered if colonoscopy is incomplete.Weak recommendation, low quality evidence. 3 When colonoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with alarm symptoms.Strong recommendation, high quality evidence.Because of lack of direct evidence, ESGE/ESGAR do not recommend CCE in this situation.Very low quality evidence.ESGE/ESGAR recommend CTC as an acceptable alternative to colonoscopy for patients with non-alarm symptoms.Strong recommendation, high quality evidence.In centers with availability, ESGE/ESGAR suggests that CCE may be considered in patients with non-alarm symptoms.Weak recommendation, low quality evidence. 4 Where there is no organized fecal immunochemical test (FIT)-based population colorectal screening program, ESGE/ESGAR recommend CTC as an option for colorectal cancer screening, providing the screenee is adequately informed about test characteristics, benefits, and risks, and depending on local service- and patient-related factors.Strong recommendation, high quality evidence.ESGE/ESGAR do not suggest CCE as a first-line screening test for colorectal cancer.Weak recommendation, low quality evidence. 5 ESGE/ESGAR recommend CTC in the case of a positive fecal occult blood test (FOBT) or FIT with incomplete or unfeasible colonoscopy, within organized population screening programs.Strong recommendation, moderate quality evidence.ESGE/ESGAR also suggest the use of CCE in this setting based on availability.Weak recommendation, moderate quality evidence. 6 ESGE/ESGAR suggest CTC with intravenous contrast medium injection for surveillance after curative-intent resection of colorectal cancer only in patients in whom colonoscopy is contraindicated or unfeasibleWeak recommendation, low quality evidence.There is insufficient evidence to recommend CCE in this setting.Very low quality evidence. 7 ESGE/ESGAR suggest CTC in patients with high risk polyps undergoing surveillance after polypectomy only when colonoscopy is unfeasible.Weak recommendation, low quality evidence.There is insufficient evidence to recommend CCE in post-polypectomy surveillance.Very low quality evidence. 8 ESGE/ESGAR recommend against CTC in patients with acute colonic inflammation and in those who have recently undergone colorectal surgery, pending a multidisciplinary evaluation.Strong recommendation, low quality evidence. 9 ESGE/ESGAR recommend referral for endoscopic polypectomy in patients with at least one polyp ≥ 6 mm detected at CTC or CCE.Follow-up CTC may be clinically considered for 6 – 9-mm CTC-detected lesions if patients do not undergo polypectomy because of patient choice, comorbidity, and/or low risk profile for advanced neoplasia.Strong recommendation, moderate quality evidence.

Performance of a deep learning system for automatic diagnosis of protruding lesions in colon capsule endoscopy: a multicentric study

“…This system allows to overcome some of the drawbacks associated with conventional colonoscopy, including the potential for pain, use of sedation, and the risk of adverse events, including bleeding and perforation 3 . The clinical application of this tool has been most extensively studied in the setting of colorectal cancer screening, particularly for patients with previous incomplete colonoscopy, or for whom the latter exam is contraindicated, unfeasible or unwanted 4 . Although CCE marks an advance in non-invasive colon evaluation, its sensitivity, particularly for polyp detection, remains suboptimal 5 .…”

Colon Capsule Endoscopy: An Alternative for Conventional Colonoscopy?

“…Colon capsule endoscopy (CCE) is a widely used non-invasive imaging, radiation-free method for directly visualizing colon and rectum. 1 CCE was initially met with skepticism, because of the need for extensive bowel cleansing protocols, long evaluation time, impossibility to take biopsies and remove polyps and high procedural costs. Concerning polyp and cancer detection, several prospective studies have compared CCE with conventional colonoscopy.…”

“…The European Society of Gastrointestinal Endoscopy (ESGE)/ European Society of Gastrointestinal and Abdominal Radiology (ESGAR) guideline recommends to consider CTC or CCE to explore proximal colonic segments in the setting of incomplete colonoscopy for non-neoplastic colonic conditions or anatomical reasons. 1 However, in case of pain or spasms as the main reason for incomplete colonoscopy, repeat colonoscopy with more sedation or CTC is advised. 1 In this study, although patient age and indications varied widely, polyp and cancer detection rates might seem rather low.…”

“…1 However, in case of pain or spasms as the main reason for incomplete colonoscopy, repeat colonoscopy with more sedation or CTC is advised. 1 In this study, although patient age and indications varied widely, polyp and cancer detection rates might seem rather low. In only 33% of all CCE procedures one or more polyps or cancer were detected.…”

Bochadek hernia: the utility of capsule endoscopy

“…After the completion of an upper endoscopy, which was normal, it was decided to perform a pan-enteric capsule endoscopy (CE), in order to observe the remaining colon and also to exclude bleeding from the small bowel [2,3].…”