Colon capsule endoscopy is a viable alternative to colonoscopy for the investigation of intermediate- and low-risk patients with gastrointestinal symptoms: results of a pilot study

Abstract

Background and study aims Colon capsule endoscopy (CCE) is a recommended viable alternative to colonoscopy for colonic visualisation in a variety of clinical settings with proven efficacy in polyp detection, surveillance, screening and Inflammatory Bowel Disease (IBD) assessment. CCE efficacy in an unselected average risk symptomatic cohort has yet to be established. The aim of this study was to determine the feasibility of CCE imaging assessment in average risk symptomatic patients as an alternative to colonoscopy with and without additional biomarker assessment.

Patients and methods This was a prospective, single-center comparison study of colonoscopy, CCE and biomarker assessment.

Results Of 77 invited subjects, 66 underwent both a CCE and colonoscopy. A fecal immunochemical test (FIT) and fecal calprotectin (FC) were available in 56 and 59 subjects. In all 64 % (n = 42) had any positive finding with 16 (24 %) found to have significant disease (high-risk adenomas, IBD) on colonoscopy. The CCE completion rate was 76 %, five (8 %) had an inadequate preparation, the CCE polyp detection rate was high at 35 %. The sensitivity, specificity, positive and negative predictive values of CCE for significant disease were 81 %, 98 %, 93 % and 94 % respectively. In addition, three (5 %) significant small bowel diagnoses were made on CCE. FC and FIT were frequently elevated in patients with both colitis (5/7, 71 %) and high-risk adenomas (4/7 57 %). While both had a low positive predictive value for clinically significant disease, FIT 32 % and FC 26 %.

Conclusions CCE is a safe and effective alternative to colonoscopy in symptomatic average risk patients with or without the addition of biomarker screening.

• References

• 1 Spada C, Hassan C, Costamagna G. Colon capsule endoscopy. Gastrointest Endosc Clin N Am 2015; 25: 387-401
• 2 Rex DK, Mark D, Clarke B. et al. Flexible sigmoidoscopy plus air-contrast barium enema versus colonoscopy for evaluation of symptomatic patients without evidence of bleeding. Gastrointest Endosc 1995; 42: 132-138
• 3 Spada C, Hassan C, Galmiche JP. et al. Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2012; 44: 527-536
• 4 Graser A, Stieber P, Nagel D. et al. Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population. Gut 2009; 58: 241-248
• 5 Mowat C, Digby J, Strachan JA. et al. Faecal haemoglobin and faecal calprotectin as indicators of bowel disease in patients presenting to primary care with bowel symptoms. Gut 2016; 65: 1463-1469
• 6 National Institute for Health and Care Excellence (NICE). Suspected cancer: recognition and referral. 2018 https://www.nice.org.uk/guidance/ng12/chapter/1-Recommendations-organised-by-site-of-cancer#lower-gastrointestinal-tract-cancers
• 7 National Institute for Health and Care Excellence (NICE). Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel. 2013 https://www.nice.org.uk/guidance/dg11
• 8 Ismail MS, Aoko O, Sihag S. et al. Lower gastrointestinal symptoms and symptoms-based triaging systems are poor predictors of clinical significant disease on colonoscopy. BMJ Open Gastroenterol 2020; 7: e000221
• 9 Hosoe N, Hayashi Y, Ogata H. Colon capsule endoscopy for inflammatory bowel disease. Clin Endosc 2020;
• 10 Holleran G, Leen R, OʼMorain 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
• 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 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
• 13 Hussey M, Holleran G, Stack R. et al. Same-day colon capsule endoscopy is a viable means to assess unexplored colonic segments after incomplete colonoscopy in selected patients. United European Gastroenterol J 2018; 6: 1556-1562
• 14 Baltes P, Bota M, Albert J. et al. PillCamColon2 after incomplete colonoscopy - A prospective multicenter study. World J Gastroenterol 2018; 24: 3556-3566
• 15 Kroijer R, Kobaek-Larsen M, Qvist N. et al. Colon capsule endoscopy for colonic surveillance. Colorectal Dis 2019; 21: 532-537
• 16 Adler SN, González Lama Y, Matallana Royo V. et al. Comparison of small-bowel colon capsule endoscopy system to conventional colonoscopy for the evaluation of ulcerative colitis activity. Endosc Int Open 2019; 7: E1253-E1261
• 17 Ohmiya N, Hotta N, Mitsufuji S. et al. Multicenter feasibility study of bowel preparation with castor oil for colon capsule endoscopy. Dig Endosc 2019; 31: 164-172
• 18 Syafiq Ismail M, Semenov S, Sihag S. et al. Improving quality in colon capsule endoscopy; effects of different bowel preparation regimens. Endoscopy 2020; 52: eP97
• 19 Semenov S, Atiyekeogbebe R, Ismail MS. et al. The addition of castor oil as a booster in colon capsule regimens significantly improves completion rates and polyp detection. Endoscopy 2020; 52: eP133
• 20 Becq A, Histace A, Camus M. et al. Development of a computed cleansing score to assess quality of bowel preparation in colon capsule endoscopy. Endosc Int Open 2018; 6: E844-e850