Colon Capsule Doesn’t Help in FIT-Positive Patients
Douglas K. Rex, MD, FASGE reviewing Pecere S, et al. Gastrointest Endosc 2019 Oct 17.
In some European countries with limited colonoscopy resources, capsule colonoscopy has been proposed as a triage screen in patients with fecal immunochemical test (FIT) positivity.
In a study from 4 screening centers in Italy and Spain, 222 FIT-positive patients were enrolled. Of these patients, 19.8% had an inadequate capsule colonoscopy study, including 8.6% (n=19) who refused to swallow the capsule and 11.3% (n=25) in whom the capsule did not pass through the full colon. Of 178 patients who had both full capsule and conventional colonoscopies, 69.7% had a polyp detected by capsule, including 6.2% (n=11) with cancer and 27.5% (n=49) with advanced adenoma (including sessile serrated polyp ≥10 mm). Using liberal polyp matching rules on a per-patient basis, with a 6-mm cutoff for referral, 52.8% of patients would be referred for colonoscopy (there were 40 patients with false-positive capsule studies). Sensitivity and specificity for advanced neoplasia were 90% and 66.1%, respectively.
At a 10-mm threshold for referral for colonoscopy, sensitivity and specificity for advanced neoplasia were 76.7% and 90.7%, respectively.
COMMENT
These results indicate that capsule use is not a good option in FIT-positive patients due to high rates of technically inadequate capsule studies, low sensitivity, and high rates of referral for colonoscopy. In general, capsule colonoscopy is best for screening in low-prevalence populations, in patients who refuse colonoscopy, or in those who appear high risk for sedation.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Douglas K. Rex, MD, FASGE
CITATION(S)
Pecere S, Senore C, Hassan C, et al. Accuracy of colon capsule for advanced neoplasia. Gastrointest Endosc 2019 Oct 17. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2019.09.041)
