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DOI: 10.1055/s-0039-1681555
THE ROLE OF COLON CAPSULE ENDOSCOPY IN COLORECTAL CANCER SCREENING: A SYSTEMATIC REVIEW
Publikationsverlauf
Publikationsdatum:
18. März 2019 (online)
Aims:
Colorectal cancer (CRC) screening programs have been implemented in many countries in order to decrease CRC incidence and mortality. Primary colonoscopy (OC) and fecal immunochemical test (FIT) are the most commonly used screening modalities. An alternative screening instrument is colon capsule endoscopy (CCE). Although the accuracy has already been proven, information on the performance of CCE in a screening population remains scarce. This is the first systematic review on the role of CCE as a CRC screening tool.
Methods:
A systematic search was conducted until November 2018 to retrieve studies from Embase, Web of Science, Medline Ovid and Cochrane Central. Studies were included when subjects underwent both CCE and OC and reported on test accuracy of CCE compared to OC in a screening population. Primary outcomes were participation, detection rate of polyps and sensitivity and specificity of any polyp. Secondary outcomes were the rate of complete colon visualization and cleansing score.
Results:
Literature search retrieved 499 studies, of these 7 met the inclusion criteria. In total 975 patients were included. All studies concerned a first (n = 6) or second (n = 1) round FIT-positive screening population. Studies that reported on participation showed rates of 8.9% and 22.9%. The polyp detection rate in CCE varied from 69% to 82%. All CRCs found during CCE were also reported during OC. Sensitivity of any polyp ranged between 79% and 98.5% and specificity between 65% and 99%. Bowel preparation was adequate in 70% to 92% and completion rate varied from 54% to 90%. No adverse events with CCE were reported in the included studies.
Conclusions:
CCE is a safe and effective diagnostic tool for the detection of cancer and polyps in a screening population. Bowel preparation is adequate in most studies, but the low completion rates affect the performance of CCE. More studies are needed to determine the role of CCE as screening instrument.
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