Semenov S, Ismail MS, Sihag S, Manoharan T, Reilly P, Boran G, Ryan B, Breslin N, O’Connor A, O’Donnell S, McNamara D. Colon capsule endoscopy is an effective filter test for colonic polyp surveillance. World J Gastrointest Endosc 2025; 17(5): 101322 [DOI: 10.4253/wjge.v17.i5.101322]
Corresponding Author of This Article
Serhiy Semenov, MRCP, Trinity Academic Gastroenterology Group, School of Medicine - Trinity College Dublin, Dublin 2, Dublin D2, Ireland. semenovs@tcd.ie
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. May 16, 2025; 17(5): 101322 Published online May 16, 2025. doi: 10.4253/wjge.v17.i5.101322
Colon capsule endoscopy is an effective filter test for colonic polyp surveillance
Serhiy Semenov, Mohd Syafiq Ismail, Sandeep Sihag, Thilagaraj Manoharan, Phyllis Reilly, Gerard Boran, Barbara Ryan, Niall Breslin, Anthony O’Connor, Sarah O’Donnell, Deirdre McNamara
Serhiy Semenov, Mohd Syafiq Ismail, Sandeep Sihag, Deirdre McNamara, Trinity Academic Gastroenterology Group, School of Medicine - Trinity College Dublin, Dublin D2, Ireland
Serhiy Semenov, Mohd Syafiq Ismail, Sandeep Sihag, Thilagaraj Manoharan, Barbara Ryan, Niall Breslin, Anthony O’Connor, Sarah O’Donnell, Deirdre McNamara, Department of Gastroenterology, Tallaght University Hospital, Dublin D24, Ireland
Phyllis Reilly, Gerard Boran, Department of Clinical Chemistry, Tallaght University Hospital, Dublin D24, Ireland
Author contributions: Semenov S and McNamara D designed the research study and wrote/edited the manuscript. Semenov S, Ismail MS, Sihag S, Manoharan T and Reilly P performed the research and assisted in data generation. Boran G, Ryan B, Breslin N, O’Connor A, O’Donnell S offered expert opinion and assisted in carrying out the research in relevant departments.
Institutional review board statement: This study was approved by the Medical Ethics Committee of St James’s Hospital/Tallaght University Hospital Research, approval No. 2019-03 List 11(04).
Clinical trial registration statement: This form is not applicable as this study is not a clinical trial.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Serhiy Semenov, MRCP, Trinity Academic Gastroenterology Group, School of Medicine - Trinity College Dublin, Dublin 2, Dublin D2, Ireland. semenovs@tcd.ie
Received: September 10, 2024 Revised: February 26, 2025 Accepted: April 11, 2025 Published online: May 16, 2025 Processing time: 243 Days and 9.3 Hours
Abstract
BACKGROUND
Surveillance colonoscopies are predominantly normal, identifying patients for potential polypectomy is advantageous.
AIM
To assess colon capsule endoscopy (CCE) and/or faecal immunochemical test (FIT) as filters in surveillance.
METHODS
Patients aged ≥ 18 due for polyp surveillance were invited for CCE and FIT. Identifying polyps or colorectal cancer resulted in a positive CCE. Significant lesions (≥ 3 polyps or ≥ 6 mm polyps), incomplete studies and positive FITs (≥ 225 ng/mL) were referred for endoscopy. CCE and endoscopy results, FIT accuracy and patient preference were assessed.
RESULTS
From a total of 126 CCEs [mean age 64 (31-80), 67 (53.2%) males), 70.6% (89/126) were excreted, 86.5% (109/126) had adequate image quality. CCE positivity was 70.6% (89/126), 42.9% (54/126) having significant polyps with 63.5% (80/126) referred for endoscopy (19 sigmoidoscopies, 61 colonoscopies). CCE reduced endoscopy need by 36.5% (46/126) and 51.6% (65/126) were spared a colonoscopy. CCE positive predictive value was 88.2% (45/51). Significant extracolonic findings were reported in 3.2% (4/126). Patients with positive CCEs were older > 65 [odds ratio (OR) = 2.5, 95% confidence interval (CI): 1.1517-5.5787, P = 0.0159], with personal history of polyps (OR = 2.3, 95%CI: 0.9734-5.4066, P = 0.045), with high/intermediate polyp surveillance risk (OR = 5.4, 95%CI: 1.1979-24.3824, P = 0.0156). Overall, 5/114 (4.4%) FITs were positive (range: 0-1394 ng/mL, mean: 54 ng/mL). Sensitivity (9.6%) and negative predictive values (20.3%) were inadequate. Receiver operating curve analysis gave a sensitivity and specificity of 26.9% and 91.7%, for FIT of 43 ng/mL. Patients preferred CCE 63.3% (76/120), with less impact on daily activities (21.7% vs 93.2%) and time off work (average days 0.9 vs 1.2, P = 0.0201).
CONCLUSION
CCE appears effective in low-risk polyp surveillance. FIT does not appear to be of benefit in surveillance.
Core Tip: This is a prospective study uniquely combining colon capsule endoscopy and the faecal immunochemical test as potential filter tests for colonic polyp surveillance patients. Given the burden of surveillance on limited endoscopy resources, we believe surveillance practice can be more balanced, in particular with respect to low risk patients who are less likely to need an invasive test and polypectomy. Our study shows that more than 50% percent of patients can avoid a full colonoscopy and that colon capsule endoscopy in particular can serve as an alternative to colonoscopy in surveillance. In contrast, faecal immunochemical test on its own underperformed in this cohort.
