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Lei II, Agache A, Robertson A, Thorndal C, Deding U, Arasaradnam R, Koulaouzidis A. Follow-up endoscopy rates as an indicator of effectiveness in colon capsule endoscopy: a systematic review and meta-analysis. BMJ Open Gastroenterol 2025; 12:e001800. [PMID: 40350168 PMCID: PMC12067854 DOI: 10.1136/bmjgast-2025-001800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2025] [Accepted: 04/10/2025] [Indexed: 05/14/2025] Open
Abstract
OBJECTIVE Colon capsule endoscopy (CCE) has emerged as a promising alternative for investigating lower gastrointestinal symptoms. However, its adoption has been limited due to concerns about cost-effectiveness, significantly influenced by follow-up endoscopy rates (FERs). Understanding CCE's FERs is crucial for its integration into routine clinical practice. We synthesised the evidence to evaluate the overall rate of further investigation in CCE. DESIGN A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Medline, Embase, and PubMed were searched through 15 August 2024. ELIGIBILITY CRITERIA Studies included reporting FERs after CCE, including subsequent endoscopic procedures and radiological imaging. There were no language restrictions or limitations in CCE referral indications, patient recruitment criteria, or pathologies investigated. DATA EXTRACTION AND SYNTHESIS All studies were independently screened and extracted two times by four reviewers. A random-effects model was used for meta-analysis and meta-regression to identify key contributing factors. RESULTS 2850 participants from 19 studies were included in the analysis. Compared with the key performance indicators for FERs in colonoscopy (0.10-0.15) and CT colonography (0.25), the pooled FER for CCE was found to be 0.42 (95% CI 0.34 to 0.50). The meta-regression analysis identified complete transit rates and adequate bowel cleansing quality as factors inversely associated with FERs. Furthermore, the CCE2 capsule demonstrated a higher reinvestigation risk than CCE1, likely due to its improved diagnostic accuracy. Although CCE indications were associated with lower FERs, subgroup analysis did not reach statistical significance with high heterogeneity. CONCLUSION This study highlights significant FERs for CCE and identifies key contributing factors, emphasising the importance of appropriate patient selection to reduce reinvestigation needs. Future research should focus on improving completion rates, bowel preparation protocols, and refining CCE indications. This will minimise environmental impact and enhance cost-effectiveness and patient satisfaction. PROSPERO REGISTRATION NUMBER CRD42024567959.
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Affiliation(s)
- Ian Io Lei
- Gastroenterology, University of Warwick, Coventry, UK
- Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, England, UK
| | - Alexandra Agache
- Department General Surgery, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Bucharest, Romania
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Alexander Robertson
- Department of Digestive Diseases, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Camilla Thorndal
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Surgery, Odense University Hospital, Odense, Denmark
| | - Ulrik Deding
- Surgery, Odense University Hospital, Svendborg, Denmark
- Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ramesh Arasaradnam
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, England, UK
- Gastroenterology, University of Warwick, Coventry, England, UK
| | - Anastasios Koulaouzidis
- Department of Surgery, Odense Universitetshospital, Odense, Region Syddanmark, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Region Syddanmark, Denmark
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Hotta N, Ohmiya N, Hiraga H, Nakaji K, Osawa S, Omori T, Mitsufuji S, Hosoe N, Nouda S, Kobayashi T, Nakamura M, Oka S, Nonogaki K, Baba Y, Mukai R, Matsumoto H, Ikebuchi Y, Shimada M, Togashi K, Katsuki S, Sasaki Y, Sawada R, Kawano S, Furuta T, Tajiri H, Tanaka S. Nationwide multicenter prospective study on the usefulness, safety, and acceptability of colon capsule endoscopy in Japan. Gastrointest Endosc 2025; 101:1051-1063.e7. [PMID: 39521091 DOI: 10.1016/j.gie.2024.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 10/21/2024] [Accepted: 11/03/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND AND AIMS We determined the factors influencing total capsule colonoscopy, adequate cleansing, and detectability of second-generation colon capsule endoscopy (CCE) for colorectal polyps or tumors (CRTs), adverse events, and acceptability. METHODS Among 44 Japanese hospitals, 1006 patients with suspected or documented colorectal diseases who underwent CCE were enrolled prospectively. RESULTS The total capsule colonoscopy rate was 86.1%. Age younger than 63 years (adjusted odds ratio [aOR], 1.525), male sex (aOR, 1.496), inflammatory bowel disease (aOR, 1.889), lavage intake on day -1 (aOR, 1.625), ≥1800-mL lavage intake on day 0 (aOR, .595), prokinetics on day 0 (aOR, .608), and ≥30-mL castor oil booster on day 0 (aOR, 1.734) were significant independent predictors. The overall adequate cleansing rate was 65.5%. Constipation (aOR, .527), lavage intake on day -1 (aOR, 1.822), laxative intake on day -1 (aOR, 2.616), and ≥1900-mL lavage intake on day 0 (aOR, 1.449) were significant independent predictors. The detection rates for patients with CRTs ≥6 mm and ≥10 mm were 92% (95% confidence interval, 84-97) and 89% (95% confidence interval, 78-96), respectively. Inadequate cleansing in the ascending colon (aOR, .184), ≥6-mm CRT in the transverse colon (aOR, 4.703), and ≥6-mm CRT in the left-sided colon (aOR, 32.013) were significant independent predictors. CCE retention occurred in 2 patients (.20%) requiring endoscopic and surgical interventions. In total, 63% of patients desired CCE for their next colonoscopy. CONCLUSIONS CCE was relatively safe, well tolerated, and useful for detecting colorectal lesions when adequate bowel preparation was made. (Clinical trial registration number: UMIN000021936.).
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Affiliation(s)
- Naoki Hotta
- Department of Internal Medicine, Masuko Memorial Hospital, Nagoya, Japan, Department of Advanced Endoscopy, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naoki Ohmiya
- Departments of Gastroenterology and Advanced Endoscopy, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroto Hiraga
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Satoshi Osawa
- Endoscopic and Photodynamic Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takafumi Omori
- Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shoji Mitsufuji
- Department of Gastroenterology, Kyoto Kujo Hospital, Kyoto, Japan
| | - Naoki Hosoe
- Center for Preventive Medicine, Keio University, Tokyo, Japan
| | - Sadaharu Nouda
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Koji Nonogaki
- Department of Gastroenterology, Daido Hospital, Nagoya, Japan
| | - Yukiko Baba
- Department of Gastroenterology, Nanpuh Hospital, Kagoshima, Japan
| | - Rieko Mukai
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroshi Matsumoto
- Division of Internal Medicine, Department of Gastroenterology, Kawasaki Medical School, Kurashiki, Japan
| | - Yuichiro Ikebuchi
- Department of Multidisciplinary Internal Medicine, Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Masaaki Shimada
- Department of Gastroenterology, NHO Nagoya Medical Center, Nagoya, Japan
| | - Kazutomo Togashi
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Shinichi Katsuki
- Department of Gastroenterology Otaru Ekisaikai Hospital, Hokkaido, Japan
| | - Yu Sasaki
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Ryoichi Sawada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Takahisa Furuta
- Center for Clinical Research, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hisao Tajiri
- Department of Innovative Interventional Endoscopy Research, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinji Tanaka
- Departments of Gastroenterology and Advanced Endoscopy, Fujita Health University School of Medicine, Toyoake, Japan
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Lei II, Robertson A, Koulaouzidis A, Arasaradnam R, the international Capsule Endoscopy Research (iCARE) Group. Evaluation of Colon Capsule Utilisation in Europe-CAPTURE EU Survey Findings. J Clin Med 2024; 14:99. [PMID: 39797183 PMCID: PMC11721665 DOI: 10.3390/jcm14010099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 12/19/2024] [Accepted: 12/25/2024] [Indexed: 01/13/2025] Open
Abstract
Background/Objectives: Colon capsule endoscopy (CCE) is a non-invasive method for visualising the colon, but its clinical adoption has been slow. Although the COVID-19 pandemic reignited interest in CCE, its role in conventional gastrointestinal investigations remains unclear, leading to varied practices across Europe. This highlights the need for a comprehensive understanding of diverse approaches to CCE in clinical practice. Method: A web-based survey was conducted from January to July 2024, targeting European gastroenterologists and colorectal surgeons interested in capsule endoscopy through the International Capsule Endoscopy Research (iCARE) Group. The survey aimed to understand CCE application across Europe and investigate factors influencing its uptake. Results: Thirty-eight (n = 38) valid responses were received from 19 European countries. While 88% reported access to CCE, only 45% had local services readily available, and just 7% included CCE in national guidelines. The most common indication for CCE was for patients who declined or could not tolerate colonoscopy (30%), with 77% of CE specialists preferring its use in fit patients. Ease of access was significantly associated with service availability (p = 0.0358). Barriers to uptake included lack of reimbursement, insufficient knowledge, and limited use in research settings. Only 27% of specialists viewed CCE positively, while 57% had a negative perception. Conclusions: This study reveals the wide variation in CCE practices and critical factors influencing its uptake. Understanding common indications and patient groups is the key to guiding its future development, particularly as AI and telemedicine enhance its potential for rapid full digestive tract visualisation.
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Affiliation(s)
- Ian Io Lei
- Institute of Precision Diagnostics & Translational Medicine, University Hospital of Coventry and Warwickshire, Clifford Bridge Rd, Coventry CV2 2DX, UK;
| | - Alexander Robertson
- Department of Digestive Diseases, University Hospitals of Leicester NHS Trust, Leicester LE1 7RH, UK;
| | - Anastasios Koulaouzidis
- Surgical Research Unit, Odense University Hospital, 5700 Svendborg, Denmark;
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
- Department of Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland
- Department of Medicine, OUH Svendborg Sygehus, 5700 Svendborg, Denmark
| | - Ramesh Arasaradnam
- Institute of Precision Diagnostics & Translational Medicine, University Hospital of Coventry and Warwickshire, Clifford Bridge Rd, Coventry CV2 2DX, UK;
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Leicester Cancer Centre, University of Leicester, Leicester LE1 7RH, UK
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Woods M, Soldera J. Colon capsule endoscopy polyp detection rate vs colonoscopy polyp detection rate: Systematic review and meta-analysis. World J Meta-Anal 2024; 12:100726. [DOI: 10.13105/wjma.v12.i4.100726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Revised: 11/11/2024] [Accepted: 11/22/2024] [Indexed: 12/12/2024] Open
Abstract
BACKGROUND Colon capsule endoscopy (CCE) is a modern, non-invasive method for large bowel visualization, offering a less invasive alternative to traditional colonoscopy (TC). While TC remains the gold standard for comprehensive large bowel assessment, including the detection and treatment of various conditions, the effectiveness of CCE in detecting polyps is less established.
AIM To systematically review and compare the polyp detection rates (PDR) of CCE and TC.
METHODS A systematic literature search was conducted using four scientific databases: CINAHL, MEDLINE via EBSCO, Cochrane Library, and MEDLINE/PubMed. A standardized search command was utilized to ensure consistency. Full papers were retrieved if they compared PDR between CCE and TC and involved patients over 18 years old. A meta-analysis was then conducted using the meta package in R software.
RESULTS Initially, 339 articles were identified, with 128 duplicates and 15 non-English articles excluded, leaving 196 for screening. After further exclusions, 9 articles were included in the review. The meta-analysis revealed minimal differences in PDR between CCE and TC. The pooled PDR for TC was 0.61 (95%CI: 0.48–0.72), and for CCE, it was 0.61 (95%CI: 0.48–0.73). The overall comparison of the pooled PDR of both methods was 0.96 (95%CI: 0.90–1.02), indicating that CCE is non-inferior to TC.
CONCLUSION CCE has emerged as a modern and safe diagnostic alternative to TC for polyp detection, demonstrating non-inferiority when compared to the conventional method.
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Affiliation(s)
- Marc Woods
- Department of Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
| | - Jonathan Soldera
- Department of Acute Medicine and Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
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Colon Capsule Endoscopy in the Diagnosis of Colon Polyps: Who Needs a Colonoscopy? Diagnostics (Basel) 2022; 12:diagnostics12092093. [PMID: 36140494 PMCID: PMC9498104 DOI: 10.3390/diagnostics12092093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 12/09/2022] Open
Abstract
Colon screening programs have reduced colon cancer mortality. Population screening should be minimally invasive, safe, acceptably sensitive, cost-effective, and scalable. The range of screening modalities include guaiac or immunochemical fecal occult blood testing and CT colonography and colonoscopy. A number of carefully controlled studies concur that second-generation capsule endoscopy has excellent sensitivity for polyp detection and a high negative predictive value. Colon capsules fulfill the screening expectation of safety, high sensitivity for polyp detection, and patient acceptance, and appear to straddle the divide between occult blood testing and colonoscopy. While meeting these criteria, there remains the challenges of scaling, capsule practitioner training, resource allocation, and implementing change of practice. Like CT colonography, capsule screening presents the clinician with a decision on the threshold for colonoscopy referral. Overall, colon capsules are an invaluable tool in polyp detection and colon screening and offer a filter that determines “who needs a colonoscopy?”.
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Deding U, Cortegoso Valdivia P, Koulaouzidis A, Baatrup G, Toth E, Spada C, Fernández-Urién I, Pennazio M, Bjørsum-Meyer T. Patient-Reported Outcomes and Preferences for Colon Capsule Endoscopy and Colonoscopy: A Systematic Review with Meta-Analysis. Diagnostics (Basel) 2021; 11:1730. [PMID: 34574071 PMCID: PMC8468090 DOI: 10.3390/diagnostics11091730] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/15/2021] [Accepted: 09/18/2021] [Indexed: 12/22/2022] Open
Abstract
Colon capsule endoscopy as an alternative to colonoscopy for the diagnosis of colonic disease may serve as a less invasive and more tolerable investigation for patients. Our aim was to examine patient-reported outcomes for colon capsule endoscopy compared to conventional optical colonoscopy including preference of investigation modality, tolerability and adverse events. A systematic literature search was conducted in Web of Science, PubMed and Embase. Search results were thoroughly screened for in- and exclusion criteria. Included studies underwent assessment of transparency and completeness, after which, data for meta-analysis were extracted. Pooled estimates of patient preference were calculated and heterogeneity was examined including univariate meta-regressions. Patient-reported tolerability and adverse events were reviewed. Out of fourteen included studies, twelve had investigated patient-reported outcomes in patients who had undergone both investigations, whereas in two the patients were randomized between investigations. Pooled patient preferences were estimated to be 52% (CI 95%: 41-63%) for colon capsule endoscopy and 45% (CI 95%: 33-57%) for conventional colonoscopy: not indicating a significant difference. Procedural adverse events were rarely reported by patients for either investigation. The tolerability was high for both colon capsule endoscopy and conventional colonoscopy. Patient preferences for conventional colonoscopy and colon capsule endoscopy were not significantly different. Procedural adverse events were rare and the tolerability for colon capsule endoscopy was consistently reported higher or equal to that of conventional colonoscopy.
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Affiliation(s)
- Ulrik Deding
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark; (G.B.); (T.B.-M.)
- Department of Surgery, Odense University Hospital, 5000 Odense, Denmark
| | - Pablo Cortegoso Valdivia
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, 43121 Parma, Italy;
| | - Anastasios Koulaouzidis
- Department of Social Medicine & Public Health, Faculty of Health Sciences, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Gunnar Baatrup
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark; (G.B.); (T.B.-M.)
- Department of Surgery, Odense University Hospital, 5000 Odense, Denmark
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, 221 00 Malmö, Sweden;
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Poliambulanza Istituto Ospedaliero, 25133 Brescia, Italy;
| | | | - Marco Pennazio
- University Division of Gastroenterology, AOU Città Della Salute e Della Scienza, University of Turin, 10124 Turin, Italy;
| | - Thomas Bjørsum-Meyer
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark; (G.B.); (T.B.-M.)
- Department of Surgery, Odense University Hospital, 5000 Odense, Denmark
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Vuik FER, Nieuwenburg SAV, Moen S, Spada C, Senore C, Hassan C, Pennazio M, Rondonotti E, Pecere S, Kuipers EJ, Spaander MCW. Colon capsule endoscopy in colorectal cancer screening: a systematic review. Endoscopy 2021; 53:815-824. [PMID: 33440442 DOI: 10.1055/a-1308-1297] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Primary colonoscopy and fecal immunochemical test (FIT) are the most commonly used colorectal cancer (CRC) screening modalities. Colon capsule endoscopy (CCE) might be an alternative. Data on the performance of CCE as a CRC screening tool in a screening population remain scarce. This is the first systematic review to provide an overview of the applicability of CCE as a CRC screening tool. METHODS A systematic search was conducted of literature published up to September 2020. Studies reporting on CRC screening by second-generation CCE in an average-risk screening population were included. RESULTS 582 studies were identified and 13 were included, comprising 2485 patients. Eight studies used CCE as a filter test after a positive FIT result and five studies used CCE for primary screening. The polyp detection rate of CCE was 24 % - 74 %. For polyps > 6 mm, sensitivity of CCE was 79 % - 96 % and specificity was 66 % - 97 %. For polyps ≥ 10 mm, sensitivity of CCE was 84 % - 97 %, which was superior to computed tomographic colonography (CTC). The CRC detection rate for completed CCEs was 93 % (25/27). Bowel preparation was adequate in 70 % - 92 % of examinations, and completion rates varied from 57 % to 92 %, depending on the booster used. No CCE-related complications were described. CONCLUSION CCE appeared to be a safe and effective tool for the detection of CRC and polyps in a screening setting. Accuracy was comparable to colonoscopy and superior to CTC, making CCE a good alternative to colonoscopy in CRC screening programs, although completion rates require improvement.
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Affiliation(s)
- Fanny E R Vuik
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Stella A V Nieuwenburg
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sarah Moen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Cristiano Spada
- Digestive Endoscopy and Gastroenterology Unit, Poliambulanza Foundation, Brescia, Italy.,Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Catholic University, Rome, Italy
| | - Carlo Senore
- Epidemiology and Screening Unit - CPO, University Hospital Città della Salute e della Scienza, Turin Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Marco Pennazio
- University Gastroenterology Unit, Città della Salute e della Scienza University Hospital, Turin, Italy
| | | | - Silvia Pecere
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A, Gemelli IRCCS, Roma, Italia
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Hosoe N, Limpias Kamiya KJL, Hayashi Y, Sujino T, Ogata H, Kanai T. Current status of colon capsule endoscopy. Dig Endosc 2021; 33:529-537. [PMID: 32542702 DOI: 10.1111/den.13769] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/16/2022]
Abstract
While both the annual incidence and mortality of colorectal cancer are slowly but steadily decreasing in the United States, the incidence of such malignancy is increasing in Japan. Thus, controlling colorectal cancer in Japan is a major concern. In 2006, colon capsule endoscopy was first introduced by Eliakim et al. First-generation colon capsule endoscopy had a moderate sensitivity for detecting polyps of more than 6 mm. Thus, second-generation colon capsule endoscopy was developed to achieve higher sensitivity. Colonoscopy is the gold standard tool for colorectal cancer surveillance. With an improvement in the imaging function, the performance of second-generation colon capsule endoscopy is almost as satisfactory as that of colonoscopy. Certain situations, such as incomplete colonoscopy and contraindication for use of sedation, can benefit from colon capsule endoscopy. Colon capsule endoscopy requires a more extensive bowel preparation than colonoscopy and computed tomography colonography because it requires laxatives not only for bowel cleansing but also for promoting the excretion of the capsule. Another problem with colon capsule endoscopy includes the burden of reading and interpretation and overlook of the lesions. Currently, the development of automatic diagnosis of colon capsule endoscopy using artificial intelligence is still under progress. Although the available guidelines do not support the use of colon capsule endoscopy for inflammatory bowel disease, the possible application of colon capsule endoscopy is ulcerative colitis. This review article summarizes and focuses on the current status of colon capsule endoscopy for colorectal cancer screening and the possibility for its applicability on inflammatory bowel disease.
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Affiliation(s)
- Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Kenji J L Limpias Kamiya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yukie Hayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomohisa Sujino
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Melson J, Trikudanathan G, Abu Dayyeh BK, Bhutani MS, Chandrasekhara V, Jirapinyo P, Krishnan K, Kumta NA, Pannala R, Parsi MA, Sethi A, Trindade AJ, Watson RR, Maple JT, Lichtenstein DR. Video capsule endoscopy. Gastrointest Endosc 2021; 93:784-796. [PMID: 33642034 DOI: 10.1016/j.gie.2020.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Joshua Melson
- Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Guru Trikudanathan
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Barham K Abu Dayyeh
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Manoop S Bhutani
- Department of Gastroenterology Hepatology and Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinay Chandrasekhara
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pichamol Jirapinyo
- Department of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kumar Krishnan
- Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nikhil A Kumta
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York, USA
| | - Rahul Pannala
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Mansour A Parsi
- Section for Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, USA
| | - Amrita Sethi
- Department of Digestive and Liver Diseases, Columbia University Medical Center/New York-Presbyterian, New York, New York, USA
| | - Arvind J Trindade
- Department of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Rabindra R Watson
- Department of Gastroenterology, Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - John T Maple
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - David R Lichtenstein
- Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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Möllers T, Schwab M, Gildein L, Hoffmeister M, Albert J, Brenner H, Jäger S. Second-generation colon capsule endoscopy for detection of colorectal polyps: Systematic review and meta-analysis of clinical trials. Endosc Int Open 2021; 9:E562-E571. [PMID: 33860073 PMCID: PMC8041571 DOI: 10.1055/a-1353-4849] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Adherence to colorectal cancer (CRC) screening is still unsatisfactory in many countries, thereby limiting prevention of CRC. Colon capsule endoscopy (CCE), a minimally invasive procedure, could be an alternative to fecal immunochemical tests or optical colonoscopy for CRC screening, and might increase adherence in CRC screening. This systematic review and meta-analysis evaluates the diagnostic accuracy of CCE compared to optical colonoscopy (OC) as the gold standard, adequacy of bowel preparation regimes and the patient perspective on diagnostic measures. Methods We conducted a systematic literature search in PubMed, EMBASE and the Cochrane Register for Clinical Trials. Pooled estimates for sensitivity, specificity and the diagnostic odds ratio with their respective 95 % confidence intervals (CI) were calculated for studies providing sufficient data. Results Of 840 initially identified studies, 13 were included in the systematic review and up to 9 in the meta-analysis. The pooled sensitivities and specificities for polyps ≥ 6 mm were 87 % (95 % CI: 83 %-90 %) and 87 % (95 % CI: 76 %-93 %) in 8 studies, respectively. For polyps ≥ 10 mm, the pooled estimates for sensitivities and specificities were 87 % (95 % CI: 83 %-90 %) and 95 % (95 % CI: 92 %-97 %) in 9 studies, respectively. A patients' perspective was assessed in 31 % (n = 4) of studies, and no preference of CCE over OC was reported. Bowel preparation was adequate in 61 % to 92 % of CCE exams. Conclusions CCE provides high diagnostic accuracy in an adequately cleaned large bowel. Conclusive findings on patient perspectives require further studies to increase acceptance/adherence of CCE for CRC screening.
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Affiliation(s)
- Tobias Möllers
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre, Heidelberg, Germany
| | - Matthias Schwab
- Dr. Margarete Fischer Bosch Institute of Clinical Pharmacology, Clinical Pharmacogenomics and Cancer, Stuttgart, Germany,Department of Clinical Pharmacology, University Hospitals Tubingen, Tubingen, Germany,Department of Pharmacy and Biochemistry, University of Tübingen, Tübingen, Germany,German Cancer Consortium, Partner Site Tubingen, Tubingen, Germany
| | - Lisa Gildein
- Department of Gastroenterology and Hepatology, Robert Bosch Hospital, Stuttgart, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre, Heidelberg, Germany
| | - Jörg Albert
- Department of Gastroenterology and Hepatology, Robert Bosch Hospital, Stuttgart, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre, Heidelberg, Germany,Division of Preventive Oncology, National Center for Tumor Diseases, Heidelberg, Germany,German Cancer Consortium, Heidelberg, Germany
| | - Simon Jäger
- Dr. Margarete Fischer Bosch Institute of Clinical Pharmacology, Clinical Pharmacogenomics and Cancer, Stuttgart, Germany,Department of Clinical Pharmacology, University Hospitals Tubingen, Tubingen, Germany
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11
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Spada C, Hassan C, Bellini D, Burling D, Cappello G, Carretero C, Dekker E, Eliakim R, de Haan M, Kaminski MF, Koulaouzidis A, Laghi A, Lefere P, Mang T, Milluzzo SM, Morrin M, McNamara D, Neri E, Pecere S, Pioche M, Plumb A, Rondonotti E, Spaander MC, Taylor S, Fernandez-Urien I, van Hooft JE, Stoker J, Regge D. Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline - Update 2020. Endoscopy 2020; 52:1127-1141. [PMID: 33105507 DOI: 10.1055/a-1258-4819] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
1: ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia.Strong recommendation, high quality evidence.ESGE/ESGAR do not recommend barium enema in this setting.Strong recommendation, high quality evidence. 2: ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. The timing depends on an interdisciplinary decision including endoscopic and radiological factors.Strong recommendation, low quality evidence.ESGE/ESGAR suggests that, in centers with expertise in and availability of colon capsule endoscopy (CCE), CCE preferably the same or the next day may be considered if colonoscopy is incomplete.Weak recommendation, low quality evidence. 3: When colonoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with alarm symptoms.Strong recommendation, high quality evidence.Because of lack of direct evidence, ESGE/ESGAR do not recommend CCE in this situation.Very low quality evidence.ESGE/ESGAR recommend CTC as an acceptable alternative to colonoscopy for patients with non-alarm symptoms.Strong recommendation, high quality evidence.In centers with availability, ESGE/ESGAR suggests that CCE may be considered in patients with non-alarm symptoms.Weak recommendation, low quality evidence. 4: Where there is no organized fecal immunochemical test (FIT)-based population colorectal screening program, ESGE/ESGAR recommend CTC as an option for colorectal cancer screening, providing the screenee is adequately informed about test characteristics, benefits, and risks, and depending on local service- and patient-related factors.Strong recommendation, high quality evidence.ESGE/ESGAR do not suggest CCE as a first-line screening test for colorectal cancer.Weak recommendation, low quality evidence. 5: ESGE/ESGAR recommend CTC in the case of a positive fecal occult blood test (FOBT) or FIT with incomplete or unfeasible colonoscopy, within organized population screening programs.Strong recommendation, moderate quality evidence.ESGE/ESGAR also suggest the use of CCE in this setting based on availability.Weak recommendation, moderate quality evidence. 6: ESGE/ESGAR suggest CTC with intravenous contrast medium injection for surveillance after curative-intent resection of colorectal cancer only in patients in whom colonoscopy is contraindicated or unfeasibleWeak recommendation, low quality evidence.There is insufficient evidence to recommend CCE in this setting.Very low quality evidence. 7: ESGE/ESGAR suggest CTC in patients with high risk polyps undergoing surveillance after polypectomy only when colonoscopy is unfeasible.Weak recommendation, low quality evidence.There is insufficient evidence to recommend CCE in post-polypectomy surveillance.Very low quality evidence. 8: ESGE/ESGAR recommend against CTC in patients with acute colonic inflammation and in those who have recently undergone colorectal surgery, pending a multidisciplinary evaluation.Strong recommendation, low quality evidence. 9: ESGE/ESGAR recommend referral for endoscopic polypectomy in patients with at least one polyp ≥ 6 mm detected at CTC or CCE.Follow-up CTC may be clinically considered for 6 - 9-mm CTC-detected lesions if patients do not undergo polypectomy because of patient choice, comorbidity, and/or low risk profile for advanced neoplasia.Strong recommendation, moderate quality evidence.
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Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy.,Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Davide Bellini
- Department of Radiological Sciences, Oncology and Pathology, La Sapienza University of Rome, Diagnostic Imaging Unit, I.C.O.T. Hospital Latina, Italy
| | | | - Giovanni Cappello
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Cristina Carretero
- Department of Gastroenterology. University of Navarre Clinic, Healthcare Research Institute of Navarre, Pamplona, Spain
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location AMC, The Netherlands
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center , Sackler School of Medicine, Tel-Aviv, Israel
| | - Margriet de Haan
- Department of Radiology, University Medical Center, Utrecht, The Netherlands
| | - Michal F Kaminski
- Departments of Gastroenterological Oncology and Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anastasios Koulaouzidis
- Endoscopy Unit, Centre for Liver and Digestive Disorders, University Hospitals, NHS Lothian, Edinburgh, UK
| | - Andrea Laghi
- Department of Surgical-Medical Sciences and Translational Medicine, La Sapienza University of Rome, Italy
| | - Philippe Lefere
- Department of Radiology, Stedelijk Ziekenhuis, Roeselare, Belgium
| | - Thomas Mang
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sebastian Manuel Milluzzo
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy.,Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Morrin
- RCSI Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Deirdre McNamara
- TAGG Research Centre, Department of Clinical Medicine, Trinity Centre, Tallaght Hospital, Dublin, Ireland
| | - Emanuele Neri
- Diagnostic Radiology 3, Department of Translational Research, University of Pisa, Italy
| | - Silvia Pecere
- Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Andrew Plumb
- Centre for Medical Imaging, University College London, London, UK
| | | | - Manon Cw Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Stuart Taylor
- Centre for Medical Imaging, University College London, London, UK
| | | | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
| | - Jaap Stoker
- Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Daniele Regge
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy.,University of Turin Medical School, Turin, Italy
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12
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Spada C, Hassan C, Bellini D, Burling D, Cappello G, Carretero C, Dekker E, Eliakim R, de Haan M, Kaminski MF, Koulaouzidis A, Laghi A, Lefere P, Mang T, Milluzzo SM, Morrin M, McNamara D, Neri E, Pecere S, Pioche M, Plumb A, Rondonotti E, Spaander MC, Taylor S, Fernandez-Urien I, van Hooft JE, Stoker J, Regge D. Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline – Update 2020. Eur Radiol 2020; 31:2967-2982. [PMID: 33104846 DOI: 10.1007/s00330-020-07413-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit and Gastronenterology, Fondazione Poliambulanza, Brescia, Italy.
- Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Davide Bellini
- Department of Radiological Sciences, Oncology and Pathology, Diagnostic Imaging Unit, La Sapienza University of Rome, I.C.O.T. Hospital, Latina, Italy
| | | | - Giovanni Cappello
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Cristina Carretero
- Department of Gastroenterology, University of Navarre Clinic, Healthcare Research Institute of Navarre, Pamplona, Spain
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location AMC, Amsterdam, The Netherlands
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Margriet de Haan
- Department of Radiology, University Medical Center, Utrecht, The Netherlands
| | - Michal F Kaminski
- Departments of Gastroenterological Oncology and Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anastasios Koulaouzidis
- Endoscopy Unit, Centre for Liver and Digestive Disorders, University Hospitals, NHS Lothian, Edinburgh, UK
| | - Andrea Laghi
- Department of Surgical-Medical Sciences and Translational Medicine, La Sapienza University of Rome, Rome, Italy
| | - Philippe Lefere
- Department of Radiology, Stedelijk Ziekenhuis, Roeselare, Belgium
| | - Thomas Mang
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sebastian Manuel Milluzzo
- Digestive Endoscopy Unit and Gastronenterology, Fondazione Poliambulanza, Brescia, Italy
- Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Morrin
- RCSI Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Deirdre McNamara
- TAGG Research Centre, Department of Clinical Medicine, Trinity Centre, Tallaght Hospital, Dublin, Ireland
| | - Emanuele Neri
- Diagnostic Radiology 3, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Silvia Pecere
- Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Andrew Plumb
- Centre for Medical Imaging, University College London, London, UK
| | | | - Manon Cw Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Stuart Taylor
- Centre for Medical Imaging, University College London, London, UK
| | | | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap Stoker
- Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Daniele Regge
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
- University of Turin Medical School, Turin, Italy
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13
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Hausmann J, Tal A, Gomer A, Philipper M, Moog G, Hohn H, Hesselbarth N, Plass H, Albert J, Finkelmeier F. Colon Capsule Endoscopy: Indications, Findings, and Complications - Data from a Prospective German Colon Capsule Registry Trial (DEKOR). Clin Endosc 2020; 54:92-99. [PMID: 32549533 PMCID: PMC7939783 DOI: 10.5946/ce.2020.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/05/2020] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Reliable and especially widely accepted preventive measures are crucial to further reduce the incidence of colorectal cancer (CRC). Colon capsule endoscopy (CCE) might increase the screening numbers among patients unable or unwilling to undergo conventional colonoscopy. This registry trial aimed to document and determine the CCE indications, findings, complications, and adverse events in outpatient practices and clinics throughout Germany.
Methods Patients undergoing CCE between 2010 and 2015 were enrolled in this prospective multicenter registry trial at six German centers. Patient demographics, outcomes, and complications were evaluated.
Results A total of 161 patients were included. Of the CCE evaluations, 111 (68.9%) were considered successful. Pathological findings in the colon (n=92, 60.1%) and in the remaining gastrointestinal tract (n=38, 24.8%) were recorded. The main finding was the presence of polyps (n=52, 32.3%). Furthermore, five carcinomas (3.1%) were detected and histologically confirmed later. Adequate bowel cleanliness was more likely to be achieved in the outpatient setting (p<0.0001). Interestingly, 85 patients (55.6%) chose to undergo CCE based on personal motivation.
Conclusions CCE seems to be a reliable and safe endoscopic tool for screening for CRC and detecting other diseases. Its patient acceptance and feasibility seems to be high, especially in the outpatient setting.
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Affiliation(s)
- Johannes Hausmann
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Hanau, Germany.,Department of Internal Medicine, St. Vinzenz-Hospital, Hanau, Germany
| | - Andrea Tal
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Hanau, Germany
| | - Artur Gomer
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Hanau, Germany
| | | | - Gero Moog
- Gastroenterologische Praxis Dr. Gero Moog, Kassel, Germany
| | - Horst Hohn
- Gastroenterologische Praxis Dr. Horst Hohn, Koblenz, Germany
| | | | - Harald Plass
- Centrum für ambulante Gastroenterologie, Nürnberg, Germany
| | - Jörg Albert
- Gastroenterologie, Hepatologie und Endokrinologie, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Fabian Finkelmeier
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Hanau, Germany
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14
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Monahan KJ, Bradshaw N, Dolwani S, Desouza B, Dunlop MG, East JE, Ilyas M, Kaur A, Lalloo F, Latchford A, Rutter MD, Tomlinson I, Thomas HJW, Hill J. Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG). Gut 2020; 69:411-444. [PMID: 31780574 PMCID: PMC7034349 DOI: 10.1136/gutjnl-2019-319915] [Citation(s) in RCA: 276] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/25/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022]
Abstract
Heritable factors account for approximately 35% of colorectal cancer (CRC) risk, and almost 30% of the population in the UK have a family history of CRC. The quantification of an individual's lifetime risk of gastrointestinal cancer may incorporate clinical and molecular data, and depends on accurate phenotypic assessment and genetic diagnosis. In turn this may facilitate targeted risk-reducing interventions, including endoscopic surveillance, preventative surgery and chemoprophylaxis, which provide opportunities for cancer prevention. This guideline is an update from the 2010 British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland (BSG/ACPGBI) guidelines for colorectal screening and surveillance in moderate and high-risk groups; however, this guideline is concerned specifically with people who have increased lifetime risk of CRC due to hereditary factors, including those with Lynch syndrome, polyposis or a family history of CRC. On this occasion we invited the UK Cancer Genetics Group (UKCGG), a subgroup within the British Society of Genetic Medicine (BSGM), as a partner to BSG and ACPGBI in the multidisciplinary guideline development process. We also invited external review through the Delphi process by members of the public as well as the steering committees of the European Hereditary Tumour Group (EHTG) and the European Society of Gastrointestinal Endoscopy (ESGE). A systematic review of 10 189 publications was undertaken to develop 67 evidence and expert opinion-based recommendations for the management of hereditary CRC risk. Ten research recommendations are also prioritised to inform clinical management of people at hereditary CRC risk.
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Affiliation(s)
- Kevin J Monahan
- Family Cancer Clinic, St Mark's Hospital, London, UK
- Faculty of Medicine, Imperial College, London, UK
| | - Nicola Bradshaw
- Clinical Genetics, West of Scotland Genetics Services, Glasgow, Glasgow, UK
| | - Sunil Dolwani
- Gastroenterology, Cardiff and Vale NHS Trust, Cardiff, UK
| | - Bianca Desouza
- Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Mohammad Ilyas
- Faculty of Medicine & Health Sciences, Nottingham University, Nottingham, UK
| | - Asha Kaur
- Head of Policy and Campaigns, Bowel Cancer UK, London, UK
| | - Fiona Lalloo
- Genetic Medicine, Central Manchester University Hospitals Foundation Trust, Manchester, UK
| | | | - Matthew D Rutter
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Ian Tomlinson
- Nuffield Department of Clinical Medicine, Wellcome Trust Centre for Human Genetics, Birmingham, UK
- Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | - Huw J W Thomas
- Family Cancer Clinic, St Mark's Hospital, London, UK
- Faculty of Medicine, Imperial College, London, UK
| | - James Hill
- Genetic Medicine, Central Manchester University Hospitals Foundation Trust, Manchester, UK
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15
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Pecere S, Senore C, Hassan C, Riggi E, Segnan N, Pennazio M, Sprujievnik T, Rondonotti E, Baccarin A, Quintero E, Adrian de Ganzo Z, Costamagna G, Spada C. Accuracy of colon capsule endoscopy for advanced neoplasia. Gastrointest Endosc 2020; 91:406-414.e1. [PMID: 31629719 DOI: 10.1016/j.gie.2019.09.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Second-generation colon capsule endoscopy (CCE-2) has shown promising accuracy for the diagnosis of overall neoplasia. Advanced neoplasia (AN) represents the main target of colorectal cancer screening programs. Our aim was to assess the diagnostic accuracy of CCE-2 for the detection of AN in patients with a positive result for the fecal immunochemical test (FIT) who are undergoing screening. METHODS Patients aged 50 to 69 years with a positive result for the FIT in 4 population screening programs in Italy and Spain were enrolled. Screenees were asked to undergo CCE-2, followed by traditional colonoscopy (TC). TC was performed the same day or the following morning. Bowel preparation included a split-dose polyethylene glycol-based regimen, with sodium phosphate (NaP) with gastrografin as boosters. The CCE-2 video was read by an endoscopist blinded to the results of TC. The main outcomes were CCE-2 accuracy in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for AN when using 2 different size thresholds for TC referral (ie, polyps ≥6 mm and ≥10 mm). RESULTS Two hundred twenty-two patients were enrolled, and 178 patients completed both CCE-2 and TC (87.7%). Overall, 59 cases of AN were detected at TC. CCE-2 sensitivity was 90%, specificity was 66.1%, PPV was 57.4%, and NPV was 92.9% for AN when using a 6-mm cut-off (TC referral rate, 52.8%) and 76.7%, 90.7%, 80.7%, and 88.4% when using a 10-mm cut-off (TC referral rate, 32%), respectively. CCE-2 detected that 8 of 9 already developed colorectal cancers. Among the 41 false positives at the 6-mm cut-off, 34 (82.9%) presented with a nonadvanced adenoma at TC. Mean transit time was 4 hours and 4 minutes, and ≥70% of patients excreted the capsule within 5 hours. CONCLUSIONS In an enriched disease setting, we showed the high sensitivity of CCE-2 for the diagnosis of AN at a 6-mm cut-off. The apparently low CCE-2 specificity is related to the choice of AN as the main outcome. (Clinical trial registration number: ISRCTN 62158762.).
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Affiliation(s)
- Silvia Pecere
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Catholic University, Rome, Italy
| | - Carlo Senore
- Epidemiology and Screening Unit - CPO, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Emilia Riggi
- Epidemiology and Screening Unit - CPO, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Nereo Segnan
- Epidemiology and Screening Unit - CPO, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Marco Pennazio
- University Gastroenterology Unit, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Tatiana Sprujievnik
- University Gastroenterology Unit, Città della Salute e della Scienza University Hospital, Turin, Italy
| | | | | | - Enrique Quintero
- Servicio de Gastroenterologia, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Departamento de Medicina Interna, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - Zaida Adrian de Ganzo
- Servicio de Gastroenterologia, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Departamento de Medicina Interna, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Catholic University, Rome, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit. Università Cattolica del Sacro Cuore, Rome, Italy
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16
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Spada C, Piccirelli S. Capsule Endoscopy. ENCYCLOPEDIA OF GASTROENTEROLOGY 2020:428-437. [DOI: 10.1016/b978-0-12-801238-3.65977-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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17
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Kroupa R, Ondrackova M, Kovalcikova P, Dastych M, Pavlik T, Kunovsky L, Dolina J. Viewpoints of the target population regarding barriers and facilitators of colorectal cancer screening in the Czech Republic. World J Gastroenterol 2019; 25:1132-1141. [PMID: 30863000 PMCID: PMC6406183 DOI: 10.3748/wjg.v25.i9.1132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/12/2019] [Accepted: 01/28/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Public awareness of colorectal cancer (CRC) and uptake of CRC screening remain challenges. The viewpoints of the target population (asymptomatic individuals older than 50) regarding CRC screening information sources and the reasons for and against participation in CRC screening are not well known in the Czech Republic. This study aimed to acquire independent opinions from the target population independently on the health system.
AIM To investigate the viewpoints of the target population regarding the source of information for and barriers and facilitators of CRC screening.
METHODS A survey among relatives (aged 50 and older) of university students was conducted. Participants answered a questionnaire about sources of awareness regarding CRC screening, reasons for and against participation, and suggestions for improvements in CRC screening. The effect of certain variables on participation in CRC screening was analyzed.
RESULTS Of 498 participants, 478 (96%) respondents had some information about CRC screening and 375 (75.3%) had participated in a CRC screening test. General practitioners (GPs) (n = 319, 64.1%) and traditional media (n = 166, 33.3%) were the most common information sources regarding CRC screening. A lack of interest or time and a fear of colonoscopy or positive results were reported as reasons for non-participation. Individuals aged > 60 years [adjusted odds ratio (aOR) = 2.30, 95% confidence interval (CI) (1.42-3.71), P = 0.001], females (aOR = 1.95, 95%CI (1.26-3.01) P = 0.003), and relatives of CRC patients (aOR = 4.17, 95%CI (1.82-9.58) P = 0.001) were more likely to participate in screening. Information regarding screening provided by physicians - GPs: (aOR = 8.11, 95%CI (4.90-13.41), P < 0.001) and other specialists (aOR = 4.19, 95%CI (1.87-9.38), P = 0.001) increased participation in screening. Respondents suggested that providing better explanations regarding screening procedures and equipment for stool capturing could improve CRC screening uptake.
CONCLUSION GPs and other specialists play crucial roles in the successful uptake of CRC screening. Reduction of the fear of colonoscopy and simple equipment for stool sampling might assist in improving the uptake of CRC screening.
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Affiliation(s)
- Radek Kroupa
- Department of Gastroenterology and Internal Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
| | - Monika Ondrackova
- Department of Hematology, Oncology and Internal Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
| | - Petra Kovalcikova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
| | - Milan Dastych
- Department of Gastroenterology and Internal Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
| | - Tomas Pavlik
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
| | - Lumir Kunovsky
- Department of Gastroenterology and Internal Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
| | - Jiri Dolina
- Department of Gastroenterology and Internal Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
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Thygesen MK, Baatrup G, Petersen C, Qvist N, Kroijer R, Kobaek-Larsen M. Screening individuals' experiences of colonoscopy and colon capsule endoscopy; a mixed methods study. Acta Oncol 2019; 58:S71-S76. [PMID: 30821625 DOI: 10.1080/0284186x.2019.1581372] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 02/05/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The standard investigation in colorectal cancer screening (optical colonoscopy [OC]) has a less invasive alternative with the colon capsule endoscopy (CCE). The experiences of screening individuals are needed to support a decision aid (DA) and to provide a patient view in future health technology assessments (HTA). We aimed to explore the experiences of CCE at home and OC in an outpatient clinic by screening participants who experienced both investigations on the same bowel preparation. METHODS In a mixed methods study, Danish screening individuals with a positive immunological fecal occult blood test (FIT) were consecutively included and underwent both CCE and OC in the same bowel preparation. They answered questionnaires about discomfort during CCE, delivered at home, and during a following OC in the outpatient clinic. Data were calculated in percentages and Wilcoxon signed rank test was used for comparisons. Among the 253 included patients, 10 participants were selected for a semi-structured interview about their experiences of the two examinations. The analysis and interpretation of the transcribed data were inspired by Ricoeur. RESULTS Questionnaire data were received from 239 participants and revealed significant less discomfort during the CCE than the OC. Interview data included explained discomfort elements in two categories: 'The examination' and 'The setting'. Compared to OC, the CCE was experienced with less pain, embarrassment and invasiveness, but presented challenges and disadvantages as well, i.e., a large camera capsule to swallow, a longer waiting time for test results after CCE and an additional OC, if pathologies were found. The home setting for CCE delivery made the participants feel less like they were ill or patients less restricted and that they received more personal care, but could induce technical challenges. CONCLUSION In screening individuals, CCE at home was associated with significantly less discomfort compared to OC at a hospital, and multiple reasons for this was identified.
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Affiliation(s)
- Marianne K Thygesen
- a Surgery Department A , Odense University Hospital , Odense , Denmark
- b Faculty of Health Sciences, Clinical Institute , University of Southern Denmark , Odense , Denmark
| | - Gunnar Baatrup
- a Surgery Department A , Odense University Hospital , Odense , Denmark
- b Faculty of Health Sciences, Clinical Institute , University of Southern Denmark , Odense , Denmark
| | | | - Niels Qvist
- a Surgery Department A , Odense University Hospital , Odense , Denmark
- b Faculty of Health Sciences, Clinical Institute , University of Southern Denmark , Odense , Denmark
| | - Rasmus Kroijer
- a Surgery Department A , Odense University Hospital , Odense , Denmark
- b Faculty of Health Sciences, Clinical Institute , University of Southern Denmark , Odense , Denmark
| | - Morten Kobaek-Larsen
- b Faculty of Health Sciences, Clinical Institute , University of Southern Denmark , Odense , Denmark
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19
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Ohmiya N, Hotta N, Mitsufuji S, Nakamura M, Omori T, Maeda K, Okuda K, Yatsuya H, Tajiri H. Multicenter feasibility study of bowel preparation with castor oil for colon capsule endoscopy. Dig Endosc 2019; 31:164-172. [PMID: 30102791 DOI: 10.1111/den.13259] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/09/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Extensive use of laxatives and incomplete excretion rates are problematic for colon capsule endoscopy (CCE). The aim of the present study was to determine the effectiveness of castor oil as a booster. METHODS At four Japanese hospitals, 319 examinees undergoing CCE were enrolled retrospectively. Before and after the introduction of castor oil, other preparation reagents were unchanged. RESULTS Of 319 examinees who underwent CCE, 152 and 167 examinees took regimens with castor oil (between November 2013 and June 2016) and without castor oil (between October 2015 and September 2017), respectively. Capsule excretion rates within its battery life in the groups with and without castor oil were 97% and 81%, respectively (P < 0.0001). Multivariate analysis showed that ages younger than 65 years (adjusted odds ratio [OR], 3.00; P = 0.0048), male gender (adjusted OR, 3.20; P = 0.0051), and use of castor oil (adjusted OR, 6.29; P = 0.0003) were predictors of capsule excretion within its battery life. Small bowel transit time was shorter and total volume of lavage and fluid intake was lower with castor oil than without (P = 0.0154 and 0.0013, respectively). Overall adequate cleansing level ratios with and without castor oil were 74% and 83%, respectively (P = 0.0713). Per-examinee sensitivity for polyps ≥6 mm with and without castor oil was 83% and 85%, respectively, with specificities of 80% and 78%, respectively. CONCLUSION Bowel preparation with castor oil was effective for improving capsule excretion rate and reducing liquid loading.
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Affiliation(s)
- Naoki Ohmiya
- Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naoki Hotta
- Department of Internal Medicine, Masuko Memorial Hospital, Nagoya, Japan
| | - Shoji Mitsufuji
- Department of Gastroenterology, Kyoto Kujo Hospital, Kyoto, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takafumi Omori
- Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kohei Maeda
- Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kotaro Okuda
- Department of Gastroenterology, Kyoto Kujo Hospital, Kyoto, Japan
| | - Hiroshi Yatsuya
- Public Health, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hisao Tajiri
- Department of Innovative Interventional Endoscopy Research, The Jikei University School of Medicine, Tokyo, Japan
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20
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Kroijer R, Dyrvig AK, Kobaek-Larsen M, Støvring JO, Qvist N, Baatrup G. Booster medication to achieve capsule excretion in colon capsule endoscopy: a randomized controlled trial of three regimens. Endosc Int Open 2018; 6:E1363-E1368. [PMID: 30410958 PMCID: PMC6221809 DOI: 10.1055/a-0732-494] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/31/2018] [Indexed: 12/14/2022] Open
Abstract
Background and study aims To achieve a complete colon capsule endoscopy, the entire colon must be visualized, clean and filled with clear fluids. The primary aim was to compare three booster regimens in colon capsule endoscopy in achieving capsule excretion within recording time. Secondary aims were quality of bowel cleansing and completion rate (both adequate cleansing and capsule excretion). Patients and methods Patients scheduled for follow-up colonoscopy due to previous neoplastic findings or familial history of colorectal cancer aged 18 to 70 years were eligible. Bowel preparation was 2-L split doses of polyethylene glycol. Patients were randomized to three booster regimens of either polyethylene glycol (Group A), sulfate-based solution (Group B) or polyethylene glycol with iodine oral contrast (Group C). Results One hundred eighty participants were included and randomized into three groups of 60. Capsule excretion was 70 % (95 % CI: 58 - 80) in Group A, 73 % (95 % CI: 61 - 83) in Group B and in 68 % (95 % CI: 56 - 79) in Group C, no statistically significant differences. Bowel cleansing grade was statistically significant better in Group B compared to Group A ( P = 0.03), but there were no statistically significant differences between Groups C and A ( P = 0.40). Complete examination rate was 65 % (95 % CI: 53 - 77), 72 % (95 % CI: 61 - 83) and 62 % (95 % CI: 50 - 74) in Group A, B and C respectively, not statistically significant different. Conclusions Sulfate-based solution resulted in statistically significant better bowel cleansing compared to polyethylene glycol. Overall the excretion and completion rate was suboptimal. Achieving a high completion rate using patient-tolerable and low-risk compounds is still a challenge.
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Affiliation(s)
- Rasmus Kroijer
- Department of Surgery, Odense University Hospital, Odense, Denmark,Department of Clinical Science, University of Southern Denmark, Denmark,Corresponding author Rasmus Kroeijer Odense University Hospital – Department of SurgeryBaagøes alle 15 Svendborg 5700Denmark
| | - Anne-Kirstine Dyrvig
- Department of Surgery, Odense University Hospital, Odense, Denmark,Odense Patient Data Explorative Network OPEN, University of Southern Denmark, Odense, Denmark
| | - Morten Kobaek-Larsen
- Department of Surgery, Odense University Hospital, Odense, Denmark,Department of Clinical Science, University of Southern Denmark, Denmark
| | | | - Niels Qvist
- Department of Surgery, Odense University Hospital, Odense, Denmark,Department of Clinical Science, University of Southern Denmark, Denmark
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Odense, Denmark,Department of Clinical Science, University of Southern Denmark, Denmark
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21
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Milluzzo SM, Bizzotto A, Cesaro P, Spada C. Colon capsule endoscopy and its effectiveness in the diagnosis and management of colorectal neoplastic lesions. Expert Rev Anticancer Ther 2018; 19:71-80. [DOI: 10.1080/14737140.2019.1538798] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Sebastian Manuel Milluzzo
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
- Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS -Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessandra Bizzotto
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
| | - Paola Cesaro
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS -Università Cattolica del Sacro Cuore, Roma, Italy
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22
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Hassan C, Kaminski MF, Repici A. How to Ensure Patient Adherence to Colorectal Cancer Screening and Surveillance in Your Practice. Gastroenterology 2018; 155:252-257. [PMID: 29964039 DOI: 10.1053/j.gastro.2018.06.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
| | - Michal F Kaminski
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre, Institute of Oncology, Warsaw, Poland
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23
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Becq A, Histace A, Camus M, Nion-Larmurier I, Abou Ali E, Pietri O, Romain O, Chaput U, Li C, Marteau P, Florent C, Dray X. Development of a computed cleansing score to assess quality of bowel preparation in colon capsule endoscopy. Endosc Int Open 2018; 6:E844-E850. [PMID: 29978004 PMCID: PMC6031442 DOI: 10.1055/a-0577-2897] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/27/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Colon capsule endoscopy (CCE) does not possess an objective and reliable scoring system to assess the quality of visualization of the colon mucosa. The aim of this study was to establish a colonic computed assessment of cleansing (CAC) score able to discriminate "adequately cleansed" from "inadequately cleansed" CCE still frames. PATIENTS AND METHODS Twelve normal and complete CCEs, using the Pillcam Colon 2 system (Medtronic, Minnesota, United States), were prospectively selected amongst a database. A CAC score, defined as the ratio of color intensities red over green (R/G ratio), and red over brown (R/(R + G) ratio) was calculated for each extracted colonic frame. After sorting and random selection, two sets of still frames representative of the range of these ratios were obtained. These images were analyzed twice in random order by two experienced CCE readers who were blinded to the CAC scores. A receiver operating characteristic (ROC) curve was forged for both types of ratios and a threshold established, yielding the highest diagnostic performance in terms of adequate cleansing assessment. RESULTS Four-hundred-and-eight frames were extracted. Regarding the R/G ratio, a threshold value of 1.55 was calculated, with a sensitivity of 86.5 % and a specificity of 77.7 %. Regarding the R/(R + G) ratio, a threshold value of 0.58 was calculated with a sensitivity of 95.5 % and a specificity of 62.9 %. CONCLUSION The two proposed CAC scores based on the ratio of color intensities come with high sensitivities for discriminating between "adequately cleansed" and "inadequately cleansed" CCE still frames, but they lack specificity. Further refinement, with implementation of additional image parameters, is warranted.
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Affiliation(s)
- Aymeric Becq
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France,Sorbonne University, Paris, France
| | - Aymeric Histace
- ETIS UMR 8051, University Paris-Seine, University of Cergy-Pontoise, ENSEA, CNRS, Cergy, France
| | - Marine Camus
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France,Sorbonne University, Paris, France
| | - Isabelle Nion-Larmurier
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France
| | - Einas Abou Ali
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France
| | - Olivia Pietri
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France,Sorbonne University, Paris, France
| | - Olivier Romain
- ETIS UMR 8051, University Paris-Seine, University of Cergy-Pontoise, ENSEA, CNRS, Cergy, France
| | - Ulriikka Chaput
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France
| | - Cynthia Li
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France,College of Arts and Sciences, Drexel University,
Philadelphia, Pennsylvania, United States
| | - Philippe Marteau
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France,Sorbonne University, Paris, France
| | - Christian Florent
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France,Sorbonne University, Paris, France
| | - Xavier Dray
- Saint-Antoine Hospital, AP-HP, Department of Hepatogastroenterology, 184 rue du Faubourg Saint Antoine, 75012 Paris, France,Sorbonne University, Paris, France,ETIS UMR 8051, University Paris-Seine, University of Cergy-Pontoise, ENSEA, CNRS, Cergy, France,Corresponding author Xavier Dray, MD, PhD Department of Digestive DiseasesSaint-Antoine Hospital – APHP184 rue du Faubourg Saint-Antoine75571 Paris cedex 12France+0033-1-49-28-29-70
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24
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Parodi A, Vanbiervliet G, Hassan C, Hebuterne X, De Ceglie A, Filiberti RA, Spada C, Conio M. Colon capsule endoscopy to screen for colorectal neoplasia in those with family histories of colorectal cancer. Gastrointest Endosc 2018; 87:695-704. [PMID: 28554656 DOI: 10.1016/j.gie.2017.05.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/14/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Colon capsule endoscopy (CCE) has been recognized as an alternative for colorectal cancer (CRC) screening in average-risk people. Our aim was to prospectively assess the accuracy of CCE as a screening tool in first-degree relatives (FDRs) of people with CRC by using optical colonoscopy (OC) with segmental unblinding as the reference standard. METHODS Consecutive patients admitted with a CRC diagnosis (index cases) were prospectively evaluated and invited to contact their FDRs. Available FDRs were invited to undergo CCE and OC on the following day, with segmental unblinding of CCE results. Sensitivity, specificity, and predictive values/negative predictive values (PPV/NPV) of CCE were assessed for detecting patients with any polyp ≥6 mm and ≥10 mm. RESULTS A total of 177 FDRs (median age 57.0 years, 54.8% female) identified from 211 index cases were included. Both CCE and OC were completed in all the included FDRs. Overall, CCE identified 51 of 56 FDRs with polyps ≥6 mm (sensitivity 91%; 95% CI, 81-96) and correctly classified as negative 107 of 121 participants without lesions ≥6 mm (specificity 88%; 95% CI, 81-93). Per-patient positive and negative predictive values for ≥6 mm lesions were 78% (95% CI, 67-87) and 95% (95% CI, 90-98), respectively. CCE detected 24 of 27 patients with polyps ≥10 mm and correctly classified as negative 142 of 150 patients, corresponding to 89% sensitivity and 95% specificity. Post-CCE referral rates to colonoscopy were 37% and 18%, respectively. CONCLUSIONS CCE is an accurate method to screen FDRs of patients with CRC and could be offered as an alternative to those who decline or are unfit for colonoscopy screening. (Clinical trial registration number: NCT01184781.).
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Affiliation(s)
- Andrea Parodi
- Gastroenterology Department, General Hospital of Sanremo, Sanremo, Italy; Gastroenterology Unit, Ospedale Galliera, Genova, Italy
| | | | - Cesare Hassan
- Gastroenterology Unit, Ospedale Nuovo Regina Margherita, Rome, Italy
| | - Xavier Hebuterne
- Gastroenterology, Hôpital Archet 2, University Hospital of Nice, Nice, France
| | | | - Rosa Angela Filiberti
- Clinical Epidemiology, IRCCS AOU San Martino-IST- Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Cristano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Massimo Conio
- Gastroenterology Department, General Hospital of Sanremo, Sanremo, Italy
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25
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Accuracy of Colon Capsule Endoscopy in Detecting Colorectal Polyps in Individuals with Familial Colorectal Cancer: Could We Avoid Colonoscopies? Gastroenterol Res Pract 2017; 2017:1507914. [PMID: 28265285 PMCID: PMC5318633 DOI: 10.1155/2017/1507914] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 12/29/2016] [Indexed: 12/11/2022] Open
Abstract
Background. Individuals with a family history of colorectal cancer (CRC) have an increased risk of CRC. We evaluated the diagnostic yield of CCE in the detection of lesions and also two different colon preparations. Methods. A prospective multicenter study was designed to assess CCE diagnostic yield in a cohort of asymptomatic individuals with a family history of CRC. CCE and colonoscopy were performed on the same day by 2 endoscopists who were blinded to the results of the other procedure. Results. Fifty-three participants were enrolled. The sensitivity, specificity, PPV, and NPV of CCE for detecting advanced adenomas were 100%, 98%, 67%, and 100%. Sensitivity, specificity, PPV, and NPV of CCE for the diagnosis of individuals with polyps were 87%, 97%, 93%, and 88%, respectively. CCE identify 100% of individuals with significant or advanced lesions. Overall cleanliness was adequate by 60.7% of them. The PEG-ascorbic boost seems to improve colon cleanliness, with similar colonic transit time. Conclusion. CCE is a promising tool, but it has to be considered as an alternative technique in this population in order to reduce the number of colonoscopies performed. More studies are needed to understand appropriate screening follow-up intervals and optimize the bowel preparation regimen.
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26
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Muguruma N, Tanaka K, Teramae S, Takayama T. Colon capsule endoscopy: toward the future. Clin J Gastroenterol 2017; 10:1-6. [PMID: 28084581 DOI: 10.1007/s12328-016-0710-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 12/18/2022]
Abstract
Colon capsule endoscopy is a wireless and minimally invasive technique for visualization of the whole colon. With recent improvements of technical features in second-generation systems, a more important role for colon capsule endoscopy is rapidly emerging. Although several limitations and drawbacks are yet to be resolved, its usefulness as a tool for colorectal cancer screening and monitoring disease activity in inflammatory bowel diseases has become more apparent with increased use. Further investigations, including multicenter trials, are required to evaluate the substantial role of the colon capsule in managing colorectal diseases.
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Affiliation(s)
- Naoki Muguruma
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.
| | - Kumiko Tanaka
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Satoshi Teramae
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Tetsuji Takayama
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
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27
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Spada C, Pasha SF, Gross SA, Leighton JA, Schnoll-Sussman F, Correale L, González Suárez B, Costamagna G, Hassan C. Accuracy of First- and Second-Generation Colon Capsules in Endoscopic Detection of Colorectal Polyps: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2016; 14:1533-1543.e8. [PMID: 27165469 DOI: 10.1016/j.cgh.2016.04.038] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/09/2016] [Accepted: 04/26/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Colon capsule endoscopy (CCE) is a noninvasive technique used to explore the colon without sedation or air insufflation. A second-generation capsule was recently developed to improve accuracy of detection, and clinical use has expanded globally. We performed a systematic review and meta-analysis to assess the accuracy of CCE in detecting colorectal polyps. METHODS We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and other databases from 1966 through 2015 for studies that compared accuracy of colonoscopy with histologic evaluation with CCE. The risk of bias within each study was ascertained according to Quality Assessment of Diagnostic Accuracy in Systematic Reviews recommendations. Per-patient accuracy values were calculated for polyps, overall and for first-generation (CCE-1) and second-generation (CCE-2) capsules. We analyzed data by using forest plots, the I2 statistic to calculate heterogeneity, and meta-regression analyses. RESULTS Fourteen studies provided data from 2420 patients (1128 for CCE-1 and 1292 for CCE-2). CCE-2 and CCE-1 detected polyps >6 mm with 86% sensitivity (95% confidence interval [CI], 82%-89%) and 58% sensitivity (95% CI, 44%-70%), respectively, and 88.1% specificity (95% CI, 74.2%-95.0%) and 85.7% specificity (95% CI, 80.2%-90.0%), respectively. CCE-2 and CCE-1 detected polyps >10 mm with 87% sensitivity (95% CI, 81%-91%) and 54% sensitivity (95% CI, 29%-77%), respectively, and 95.3% specificity (95% CI, 91.5%-97.5%) and 97.4% specificity (95% CI, 96.0%-98.3%), respectively. CCE-2 identified all 11 invasive cancers detected by colonoscopy. CONCLUSIONS The sensitivity in detection of polyps >6 mm and >10 mm increased substantially between development of first-generation and second-generation colon capsules. High specificity values for detection of polyps by CCE-2 seem to be achievable with a 10-mm cutoff and in a screening setting.
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Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy.
| | - Shabana F Pasha
- Division of Gastroenterology, Mayo Clinic School of Medicine, Scottsdale, Arizona
| | - Seth A Gross
- Department of Gastroenterology, Tisch Hospital, NYU Langone Medical Center, New York, New York
| | - Jonathan A Leighton
- Division of Gastroenterology, Mayo Clinic School of Medicine, Scottsdale, Arizona
| | - Felice Schnoll-Sussman
- Department of Gastroenterology, Weill Medical College of Cornell University, New York, New York
| | | | | | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy; Department of Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
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28
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Carter D, Eliakim R. PillCam colon capsule endoscopy (PCCE) in colonic diseases. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:307. [PMID: 27668227 DOI: 10.21037/atm.2016.08.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diseases affecting the colon are common worldwide and can cause a major health problem. Colorectal cancer (CRC) as well as Inflammatory bowel diseases represent a major cause of morbidity and mortality in western countries. PillCam colon capsule endoscopy (PCCE) is a novel and promising technology that can be useful for the screening and monitoring of colonic diseases. In the recent years many articles examined the use of various versions of PCCE-the 1st and 2nd generation versus various other endoscopic or radiologic modalities both for detection of colonic polyps or cancer and in both ulcerative colitis (UC) and Crohn's disease. The aim of the current review is to provide up to date information regarding the use and usefulness of this method in these disease.
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Affiliation(s)
- Dan Carter
- Department of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rami Eliakim
- Department of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Han YM, Im JP. Colon Capsule Endoscopy: Where Are We and Where Are We Going. Clin Endosc 2016; 49:449-453. [PMID: 27653441 PMCID: PMC5066410 DOI: 10.5946/ce.2016.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/07/2016] [Indexed: 12/11/2022] Open
Abstract
Colon capsule endoscopy (CCE) is a noninvasive technique for diagnostic imaging of the colon. It does not require air inflation or sedation and allows minimally invasive and painless colonic evaluation. The role of CCE is rapidly evolving; for example, for colorectal screening (colorectal cancer [CRC]) in average-risk patients, in patients with an incomplete colonoscopy, in patients refusing a conventional colonoscopy, and in patients with contraindications for conventional colonoscopy. In this paper, we comprehensively review the technical characteristics and procedure of CCE and compare CCE with conventional methods such as conventional colonoscopy or computed tomographic colonography. Future expansion of CCE in the area of CRC screening for the surveillance of polyps and adenomatous lesions and for assessment of inflammatory bowel disease is also discussed.
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Affiliation(s)
- Yoo Min Han
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Morgan DR, Malik PR, Romeo DP, Rex DK. Initial US evaluation of second-generation capsule colonoscopy for detecting colon polyps. BMJ Open Gastroenterol 2016; 3:e000089. [PMID: 27195129 PMCID: PMC4860721 DOI: 10.1136/bmjgast-2016-000089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/16/2016] [Accepted: 04/07/2016] [Indexed: 12/16/2022] Open
Abstract
Objectives Capsule colonoscopy is an additional screening modality for colorectal cancer. Second-generation capsule colonoscopy (CC2) may have improved efficacy in the detection of colon adenomas as compared with prior devices. The purpose of this study was to evaluate the performance of CC2 in the detection of polyps in symptomatic and screening patients in the USA. Design Prospective, multicentre study. Setting and participants Two academic medical centres and two private practice facilities, evaluating patients with indications for colonoscopy. Methods Patients underwent capsule colonoscopy procedure using magnesium citrate as a boost, followed by colonoscopy on the same day. The main outcome measurement was accuracy of CC2 for the detection of colorectal polyps ≥6 and ≥10 mm as compared with conventional colonoscopy. Results 51 patients were enrolled, 50 of whom had CC2 and colonoscopy examinations and were included in the accuracy analysis. 30% and 14% of patients had polyps ≥6 and ≥10 mm, respectively. For lesions ≥10 mm identified on conventional colonoscopy, CC2 sensitivity was 100% (95% CI 56.1% to 100%) with a specificity of 93.0% (79.9% to 98.2%). For polyps ≥6 mm, the CC2 sensitivity was 93.3% (66.0% to 99.7%) and the specificity was 80.0% (62.5% to 90.9%). There was a 61% adequate cleansing rate with 64% of CC2 procedures being complete. Conclusions In the initial US experience with CC2 there was adequate sensitivity for detecting patients with polyps ≥6 mm in size. Magnesium citrate was inadequate as a boost agent. Trial registration number NCT01087528.
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Affiliation(s)
- Douglas R Morgan
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition , Vanderbilt Institute for Global Health, Vanderbilt University , Nashville, Tennessee , USA
| | - Pramod R Malik
- Gastroenterology Associates of Tidewater, P.C , Virginia Gastroenterology Institute , Suffolk, Virginia , USA
| | - David P Romeo
- Dayton Gastroenterology, Inc. , Beavercreek, Ohio , USA
| | - Douglas K Rex
- Department of Medicine, Division of Gastroenterology/Hepatology , Indiana University Hospital , Indianapolis, Indiana , USA
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Spada C, Hassan C, Costamagna G. Colon Capsule Endoscopy in Colorectal Cancer Screening: A Rude Awakening From a Beautiful Dream? Clin Gastroenterol Hepatol 2015; 13:2302-4. [PMID: 26325396 DOI: 10.1016/j.cgh.2015.08.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 08/19/2015] [Accepted: 08/19/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
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