Colon capsule endoscopy vs. colonoscopy in patients at average or increased risk of colorectal cancer

Aliment Pharmacol Ther 2010; 32: 1145–1153 Summary Background Colon capsule endoscopy (CCE) is a new, non-invasive technology. Aim To conduct a prospective, multicentre trial to compare CCE and colonoscopy in asymptomatic subjects enrolled in screening or surveillance programmes for the detection of colorectal neoplasia. Methods Patients underwent CCE on day one and colonoscopy (gold standard) on day two. CCE and colonoscopy were performed by independent endoscopists. Results A total of 545 patients were recruited. CCE was safe and well-tolerated. Colon cleanliness was excellent or good in 52% of cases at CCE. Five patients with cancer were detected by colonoscopy, of whom two were missed by CCE. CCE accuracy for the detection of polyps ≥6 mm was 39% (95% CI 30–48) for sensitivity, 88% (95% CI 85–91) for specificity, 47% (95% CI 37–57) for positive predictive value and 85% (95% CI 82–88) for negative predictive value. CCE accuracy was better for the detection of advanced adenoma, in patients with good or excellent cleanliness and after re-interpretation of the CCE videos by an independent expert panel. Conclusions Although well-tolerated, CCE cannot replace colonoscopy as a first line investigation for screening and surveillance of patients at risk of cancer. Further studies should pay attention to colonic preparation (Clinicaltrial.gov number NCT00436514).