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Colon Capsule Endoscopy Scorches CT Colonography in Fecal Immunochemical Test-Positive Trial

Douglas K. Rex, MD, MASGE, reviewing González-Suárez B, et al. BMC Med 2020 Sep 18.

Comparative trials in patients with prior incomplete colonoscopy suggest that colon capsule endoscopy (CCE) detects polyps with higher sensitivity than CT colonography (CTC). In the first randomized head-to-head comparison of CCE versus CTC before a full colonoscopy, 349 individuals with a positive fecal immunochemical test (FIT) result from the Barcelona colorectal screening program were randomized to CCE versus CTC. The primary end point was diagnostic characteristics of CTC and CCE in the detection of colorectal neoplasia. Examinations using CTC were done without full laxative preparation, and 18.3% of the CCE examinations were not evaluable for technical reasons (mostly failure to reach the rectum). For detecting any neoplastic lesion ≥6 mm, sensitivity and specificity were 96.1% and 88.2%, respectively, with CCE versus 79.3% and 96.3%, respectively, with CTC. For any neoplastic lesion ≥10 mm, CCE and CTC sensitivities were 97.3% and 90.0%, respectively, and specificities were 95.3% and 99%, respectively. Perhaps most telling, CCE detected 83.2% (298 out of 358 lesions) of lesions versus 42.8% (119 out of 278 lesions) with CTC (P<.001).

Douglas K. Rex, MD, FASGE

COMMENT

The idea that patients with positive FIT results should undergo anything other than colonoscopy as their initial evaluation is a bad idea. Further, the sensitivities for both arms are likely inflated compared to what is achievable in a screening population because of the high prevalence of disease. 

Nevertheless, the comparison between CCE and CTC is informative and again suggests that CCE outperforms CTC for sensitivity in polyp detection. Given that CCE just received a Category I CPT code for incomplete colonoscopy, GI centers may wish to consider how they can add CCE capability and how to perform it logistically in patients with incomplete colonoscopies as an alternative to CTC. Of course, repeat colonoscopy by an expert colonoscopist is generally the best option after incomplete colonoscopy for redundancy or sigmoid angulation.

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.

CITATION(S)

González-Suárez B, Pagés M, Araujo IK, et al. Colon capsule endoscopy versus CT colonography in FIT-positive colorectal cancer screening subjects: A prospective randomised trial–the VICOCA study. BMC Med 2020;18:255. (https://doi.org/10.1186/s12916-020-01717-4)

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