Colon capsule endoscopy in colorectal cancer screening: a systematic review

Abstract

Introduction Primary colonoscopy and fecal immunochemical test (FIT) are the most commonly used colorectal cancer (CRC) screening modalities. Colon capsule endoscopy (CCE) might be an alternative. Data on the performance of CCE as a CRC screening tool in a screening population remain scarce. This is the first systematic review to provide an overview of the applicability of CCE as a CRC screening tool.

Methods A systematic search was conducted of literature published up to September 2020. Studies reporting on CRC screening by second-generation CCE in an average-risk screening population were included.

Results 582 studies were identified and 13 were included, comprising 2485 patients. Eight studies used CCE as a filter test after a positive FIT result and five studies used CCE for primary screening. The polyp detection rate of CCE was 24 % – 74 %. For polyps > 6 mm, sensitivity of CCE was 79 % – 96 % and specificity was 66 % – 97 %. For polyps ≥ 10 mm, sensitivity of CCE was 84 % – 97 %, which was superior to computed tomographic colonography (CTC). The CRC detection rate for completed CCEs was 93 % (25/27). Bowel preparation was adequate in 70 % – 92 % of examinations, and completion rates varied from 57 % to 92 %, depending on the booster used. No CCE-related complications were described.

Conclusion CCE appeared to be a safe and effective tool for the detection of CRC and polyps in a screening setting. Accuracy was comparable to colonoscopy and superior to CTC, making CCE a good alternative to colonoscopy in CRC screening programs, although completion rates require improvement.

Publikationsverlauf

Eingereicht: 15. Januar 2020

Angenommen: 21. Oktober 2020

Artikel online veröffentlicht:
13. Januar 2021

• References

• 1 Senore C, Basu P, Anttila A. et al. Performance of colorectal cancer screening in the European Union Member States: data from the second European screening report. Gut 2019; 68: 1232-1244
• 2 Schreuders EH, Ruco A, Rabeneck L. et al. Colorectal cancer screening: a global overview of existing programmes. Gut 2015; 64: 1637-1649
• 3 Pasha SF. Applications of colon capsule endoscopy review. Curr Gastroenterol Rep 2018; 20: 22
• 4 Spada C, Barbaro F, Andrisani G. et al. Colon capsule endoscopy: what we know and what we would like to know. World J Gastroenterol 2014; 20: 16948-16955
• 5 Spada C, Hassan C, Marmo R. et al. Meta-analysis shows colon capsule endoscopy is effective in detecting colorectal polyps. Clin Gastroenterol Hepatol 2010; 8: 516-522
• 6 Spada C, Pasha SF, Gross SA. et al. Accuracy of first- and second-generation colon capsules in endoscopic detection of colorectal polyps: a systematic review and meta-analysis review. Clin Gastroenterol Hepatol 2016; 14: 1533-1543
• 7 FDA expands indication for PillCam Colon 2 capsule. FDA. Available at (Accessed 30 April 2020): https://www.healio.com/gastroenterology/interventional-endoscopy/news/online/%7Bbe015b5b-0375-413a-9c4f-abf60bc3ac71%7D/fda-expands-indication-for-pillcam-colon-2-capsule
• 8 Spada C, Hassan C, Galmiche JP. et al. Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2012; 44: 527-535
• 9 Whiting PF, Rutjes AW, Westwood ME. et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155: 529-536
• 10 Cash BD, Fleisher MR, Fern S. et al. A Multicenter, prospective, randomized study comparing the diagnostic yield of colon capsule endoscopy versus computed tomographic colonography in a screening population Results of the TOPAZ study. Gastrointest Endosc 2019; 89 : AB87-AB88
• 11 Kobaek-Larsen M, Kroijer R, Dyrvig AK. et al. Back-to-back colon capsule endoscopy and optical colonoscopy in colorectal cancer screening individuals. Colorectal Dis 2018; 20: 479-485
• 12 Thygesen MK, Baatrup G, Petersen C. et al. Screening individuals’ experiences of colonoscopy and colon capsule endoscopy; a mixed methods study. Acta Oncol 2019; 58: S71-S76
• 13 Romero C, De Miguel CR, Serradesanferm A. et al. Pillcam^© colon capsule for colorectal cancer screening: a prospective and comparative study with colonoscopy. Gastroenterology 2015; 148: S759
• 14 Suchanek S, Grega T, Voska M. et al. The efficiency of colonic capsule endoscopy in detection of colorectal polyps and cancers compared to colonoscopy – final results of multicenter, prospective, cross-over study. Gastrointest Endosc 2015; 81: AB265
• 15 Holleran G, Leen R, O’Morain C. et al. Colon capsule endoscopy as possible filter test for colonoscopy selection in a screening population with positive fecal immunology. Endoscopy 2014; 46: 473-478
• 16 Rex DK, Adler SN, Aisenberg J. et al. Accuracy of capsule colonoscopy in detecting colorectal polyps in a screening population. Gastroenterology 2015; 148: 948-967
• 17 Pecere S, Senore C, Hassan C. et al. Accuracy of colon capsule endoscopy for advanced neoplasia. Gastrointest Endosc 2020; 91: 406-414
• 18 Voska M, Zavoral M, Grega T. et al. Accuracy of colon capsule endoscopy for colorectal neoplasia detection in individuals referred for a screening colonoscopy. Gastroenterol Res Pract 2019; 2019: 5975438
• 19 Pioche M, Ganne C, Gincul R. et al. Colon capsule versus computed tomography colonography for colorectal cancer screening in patients with positive fecal occult blood test who refuse colonoscopy: a randomized trial. Endoscopy 2018; 50: 761-769
• 20 Rondonotti E, Borghi C, Mandelli G. et al. Accuracy of capsule colonoscopy and computed tomographic colonography in individuals with positive results from the fecal occult blood test. Clin Gastroenterol Hepatol 2014; 12: 1303-1310
• 21 Gonzalez-Suarez B, Pages M, Araujo IK. et al. Colon capsule endoscopy versus CT colonography in FIT-positive colorectal cancer screening subjects: a prospective randomised trial – the VICOCA study. BMC Med 2020; 18: 255
• 22 Groth S, Krause H, Behrendt R. et al. Capsule colonoscopy increases uptake of colorectal cancer screening. BMC Gastroenterol 2012; 12: 80
• 23 Rembacken B, Hassan C, Riemann JF. et al. Quality in screening colonoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE). Endoscopy 2012; 44: 957-968
• 24 Singhal S, Nigar S, Paleti V. et al. Bowel preparation regimens for colon capsule endoscopy: a review. Therap Adv Gastroenterol 2014; 7: 115-122
• 25 Leighton JA, Rex DK. A grading scale to evaluate colon cleansing for the PillCam COLON capsule: a reliability study. Endoscopy 2011; 43: 123-127
• 26 Lim YJ, Joo YS. Korean Gut Image Study Group. et al. Learning curve of capsule endoscopy. Clin Endosc 2013; 46: 633-636
• 27 Adrian-de-Ganzo Z, Alarcon-Fernandez O, Ramos L. et al. Uptake of colon capsule endoscopy vs colonoscopy for screening relatives of patients with colorectal cancer. Clin Gastroenterol Hepatol 2015; 13: 2293-2301