Meta-analysis shows colon capsule endoscopy is effective in detecting colorectal polyps.
OBJECTIVE
Colon capsule endoscopy (CCE) is a noninvasive and painless technique used to explore the colon without sedation or air insufflation. We performed a systematic review and meta-analysis to assess the accuracy of CCE in detecting colorectal polyps.


METHODS
The MEDLINE, EMBASE, and SCOPUS databases were searched, from 2006 to 2009, for the terms "colon capsule" and "Pillcam colon"; searches included abstracts. Studies were included that focused on detecting colorectal polyps with CCE and that were verified using within-subject reference colonoscopy. The risk of bias within each study was ascertained according to Quality Assessment of Diagnostic Accuracy in Systematic Reviews recommendations. The per-patient sensitivity and specificity were calculated for polyps of any size and for significant findings (polyps, > or =6 mm in size or >3 in number). Forest plots were produced based on random-effect models. The risk of bias across studies was assessed using the interstudy heterogeneity statistic, meta-regression, and the Egger test.


RESULTS
Eight studies provided data on 837 patients; the prevalences of polyps and significant findings were 57% and 27.4%, respectively. CCE sensitivity for polyps of any size and significant findings were 71% and 68%, respectively. CCE specificity for polyps of any size and significant findings were 75% and 82%, respectively. High levels of heterogeneity (interstudy heterogeneity, >75%) were not detected. Moderate heterogeneity partially was explained by the different design of individual studies. CCE identified 16 of the 21 cancerous lesions detected by colonoscopy (pooled sensitivity, 76%).


CONCLUSIONS
CCE sensitivity for polyps and significant findings compares favorably with other noninvasive colorectal cancer screening strategies. CCE specificity is likely to be underestimated because reference colonoscopy examination results are blinded.
Spada
Cristiano
C
Digestive Endoscopy Unit, Catholic University, Rome, Italy. cristianospada@gmail.com
Hassan
Cesare
C
Marmo
Riccardo
R
Petruzziello
Lucio
L
Riccioni
Maria Elena
ME
Zullo
Angelo
A
Cesaro
Paola
P
Pilz
Julia
J
Costamagna
Guido
G
D053704:Capsule Endoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis*; D012680:Sensitivity and Specificity