NEJM: Capsule cam falls short of colonoscopy

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The use of capsule endoscopy of the colon allows visualization of the colonic mucosa in most patients, but its sensitivity for detecting colonic lesions is low compared with the use of optical colonoscopy, according to a prospective, multicenter study in the July 16 issue of the New England Journal of Medicine.

An ingestible capsule (PillCam SB from Given Imaging) consisting of an endoscope equipped with a video camera at both ends was designed to explore the colon. André Van Gossum, MD, from the department of gastroenterology, hepatopancreatology and gastrointestinal oncology at Erasme University Hospital, Université Libre de Bruxelles in Brussels, Belgium, and colleagues undertook the study to compare capsule endoscopy with optical colonoscopy for the detection of colorectal polyps and cancer.

The researchers performed the study in a cohort of patients with known or suspected colonic disease for the detection of colorectal polyps or cancer. Patients underwent an adapted colon preparation, and colon cleanliness was graded from poor to excellent. They computed the sensitivity and specificity of capsule endoscopy for polyps, advanced adenoma and cancer. A total of 328 patients (mean age, 58.6 years) were included.

Van Gossum and colleagues noted that the capsule was excreted within 10 hours after ingestion and before the end of the lifetime of the battery in 92.8 percent of the patients. They found that the sensitivity and specificity of capsule endoscopy for detecting polyps 6 mm in size or bigger were 64 percent and 84 percent, respectively, and for detecting advanced adenoma, the sensitivity and specificity were 73 percent and 79 percent, respectively.

Of 19 cancers detected by colonoscopy, the capsule endoscopy detected 14 (sensitivity, 74 percent).

However, the authors noted that colon cleanliness significantly influences the sensitivity of capsule endoscopy. For all lesions, the sensitivity of capsule endoscopy was higher in patients with good or excellent colon cleanliness than in those with fair or poor colon cleanliness. However, mild-to-moderate adverse events were reported in 26 patients (7.9 percent) and were mostly related to the colon preparation.

The study was funded by the Yoqneam, Israel-based Given Imaging.