Colon Capsule Endoscopy Compared to Conventional Colonoscopy under Routine Screening Conditions

Julia B Pilz; Susanne Portmann; Shajan Peter; Christoph Beglinger; Lukas Degen

BMC Gastroenterol. 2010;10(56)

Abstract and Introduction

Abstract

Background: Colonoscopy (CSPY) for colorectal cancer screening has several limitations. Colon Capsule Endoscopy (PillCam Colon, CCE) was compared to CSPY under routine screening conditions.
Methods: We performed a prospective, single-center pilot study at a University Hospital. Data were obtained from November 2007 until May 2008. Patients underwent CCE on Day 1 and CSPY on Day 2. Outcomes were evaluated regarding sensitivity and specificity of polyp detection rate, with a significance level set at >5 mm.
Results: 59 individuals were included in this study, the results were evaluable in 56 patients (males 34, females 22; median age 59). CCE was complete in 36 subjects. Polyp detection rate for significant polyps was 11% on CSPY and 27% on CCE.
6/56 (11%) patients had polyps on CSPY not detected on CCE (miss rate).
Overall sensitivity was 79% (95% confidence interval [CI], 61 to 90), specificity was 54% (95% CI, 35 to 70), positive predictive value (PPV) was 63% and negative predictive value (NPV) was 71%. Adjusted to significance of findings, sensitivity was 50% (95% CI, 19 to 81), specificity was 76% (95% CI, 63 to 86), PPV was 20% and NPV was 93%.
Conclusion: In comparison to the gold standard, the sensitivity of CCE for detection of relevant polyps is low, however, the high NPV supports its role as a possible screening tool.

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Cite this: Colon Capsule Endoscopy Compared to Conventional Colonoscopy under Routine Screening Conditions - Medscape - Jun 01, 2010.

Abstract and Introduction
Background
Methods
Results
Discussion
Conclusion
References

Table 1. Summary of bowel preparation
Time (hours)	Action
Day -3
all day	Low-fibre diet
Day -2
all day	liquid diet
Day -1
all day	clear liquids only
18:00–19:30	2 Liters of Cololyt® (1 cup every 10–15 minutes)
Exam day
7:00–8:30	2 Liters of Cololyt® (1 cup every 10–15 minutes)
11:00	20 mg Domperidone (Motilium®) with a cup of water
11:15	Ingestion of PillCam® Colon with a cup of water
until 13:00	no food/liquid ingestion
13:00	Real time view assessment if capsule left stomach, then Booster dose of 45 ml Colophos® + 1 liter of water
17:00	Real time view assessment if capsule left stomach, then Booster dose of 30 ml Colophos® + 1 liter of water *)
19:30	10 mg Bisacodylum rectal suppository *)
22:00	End of examination
Day +1	Conventional colonoscopy
	*) This action was taken only if PillCam® Colon had not been excreted by this time.

Table 2. Description of colon cleansing level
Grade	Description
1	clean, small amount of feces/dark fluid, good assessability
2	moderate preparation due to remaining feces/dark fluid, limited assessability but clean enough to preclude significant lesions
3	poor preparation, enough feces/fluid to strongly limit assessability

Table 3. Indications/symptoms (n = 56)
Screening	23 (41%)
Family history	4 (7%)
Follow-up after polypectomy	3 (5%)
Abdominal pain	8 (14%)
Bleeding frank	8 (14%)
Anemia	2 (4%)
Change in bowel habits	6 (11%)
Diarrhea	1 (2%)
Weight loss	1 (2%)

Table 4. CCE: Sensitivity, Specificity, PPV and NPV for any size polyps and significant size (>5 mm) polyps
	For polyps of any size	For polyps >5 mm
Sensitivity % (95% CI)	79 (61–90)	50 (19–81)
Specificity % (95% CI)	54 (35–70)	76 (36–86)
Positive predictive value %	63	20
Negative predictive value %	71 χ² : p = 0.013	93 χ² : p > 0.05

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