Capsule endoscopy versus colonoscopy for the detection of polyps and cancer.
BACKGROUND
An ingestible capsule consisting of an endoscope equipped with a video camera at both ends was designed to explore the colon. This study compared capsule endoscopy with optical colonoscopy for the detection of colorectal polyps and cancer.


METHODS
We performed a prospective, multicenter study comparing capsule endoscopy with optical colonoscopy (the standard for comparison) in a cohort of patients with known or suspected colonic disease for the detection of colorectal polyps or cancer. Patients underwent an adapted colon preparation, and colon cleanliness was graded from poor to excellent. We computed the sensitivity and specificity of capsule endoscopy for polyps, advanced adenoma, and cancer.


RESULTS
A total of 328 patients (mean age, 58.6 years) were included in the study. The capsule was excreted within 10 hours after ingestion and before the end of the lifetime of the battery in 92.8% of the patients. The sensitivity and specificity of capsule endoscopy for detecting polyps that were 6 mm in size or bigger were 64% (95% confidence interval [CI], 59 to 72) and 84% (95% CI, 81 to 87), respectively, and for detecting advanced adenoma, the sensitivity and specificity were 73% (95% CI, 61 to 83) and 79% (95% CI, 77 to 81), respectively. Of 19 cancers detected by colonoscopy, 14 were detected by capsule endoscopy (sensitivity, 74%; 95% CI, 52 to 88). For all lesions, the sensitivity of capsule endoscopy was higher in patients with good or excellent colon cleanliness than in those with fair or poor colon cleanliness. Mild-to-moderate adverse events were reported in 26 patients (7.9%) and were mostly related to the colon preparation.


CONCLUSIONS
The use of capsule endoscopy of the colon allows visualization of the colonic mucosa in most patients, but its sensitivity for detecting colonic lesions is low as compared with the use of optical colonoscopy. (ClinicalTrials.gov number, NCT00604162.)
Van Gossum
André
A
Department of Gastroenterology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. andre.vangossum@erasme.ulb.ac.be
Munoz-Navas
Miguel
M
Navas
Miguel Munoz
MM
Fernandez-Urien
Iñaqui
I
Carretero
Cristina
C
Gay
Gérard
G
Delvaux
Michel
M
Lapalus
Marie Georges
MG
Ponchon
Thierry
T
Neuhaus
Horst
H
Philipper
Michael
M
Costamagna
Guido
G
Riccioni
Maria Elena
ME
Spada
Cristiano
C
Petruzziello
Lucio
L
Fraser
Chris
C
Postgate
Aymer
A
Fitzpatrick
Aine
A
Hagenmuller
Friedrich
F
Keuchel
Martin
M
Schoofs
Nathalie
N
Devière
Jacques
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053705:Capsule Endoscopes; D053704:Capsule Endoscopy; D003111:Colonic Polyps / Q000175:diagnosis*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000033:anatomy & histology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult