Robert H. Fletcher, MD
How accurate is capsule endoscopy for detecting colorectal polyps and cancer in adults with known or suspected colonic disease?
Blinded comparison of capsule endoscopy and colonoscopy. ClinicalTrials.gov NCT00604162.
8 centers in Belgium, France, Germany, Italy, Spain, and the UK.
332 adults (mean age 59 y and 55% men based on 320 patients analyzed), who were scheduled to have colonoscopy because of known colonic disease in patients ≥ 18 years of age or suspected colonic disease in patients ≥ 50 years of age. Exclusion criteria included dysphagia, congestive heart failure, renal insufficiency, intestinal obstruction, abdominal surgery in the past 6 months, life-threatening conditions, use of implantable electromedical devices, and pregnancy.
Capsule endoscopy using ingestible PillCam COLON capsules, which have an endoscope with an imager at each end. Patients ingested capsules after colon preparation without colon insufflation or sedation. Capsules were naturally excreted.
Optical colonoscopy for polyp detection and colonoscopy plus biopsy for detection of adenomas and cancer.
Included sensitivity and specificity for detecting colonic polyps, advanced adenomas (size ≥ 1 cm or with villous features or high-grade dysplasia), and carcinomas.
Capsule endoscopy had low-to-moderate sensitivity for detecting polyps, advanced adenomas, and cancer; specificity was high for polyps and advanced adenomas ≥ 10 mm and low for cancer and smaller polyps and advanced adenomas (Table).
In patients with known or suspected colonic disease, capsule endoscopy had low sensitivity but high specificity for detecting large polyps and advanced adenomas; accuracy for detecting colorectal cancer was limited.
Capsule endoscopy for detecting colorectal polyps, adenomas, and cancer in patients with known or suspected colonic disease*
*Diagnostic terms defined in Glossary. LRs calculated from data in article.
†Gold standard = colonoscopy.
‡Gold standard = colonoscopy plus biopsy.
Fletcher RH. Capsule endoscopy had low sensitivity for detecting colonic lesions and high specificity for large lesions. Ann Intern Med. ;151:JC5–11. doi: 10.7326/0003-4819-151-10-200911170-02011
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Published: Ann Intern Med. 2009;151(10):JC5-11.
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