Real-life practice data on colon capsule endoscopy: We need them fast!

We read with interest the report on colon capsule endoscopy (CCE) in clinical practice: lessons from a national 5-year observational prospective cohort, by Benech et al. on behalf of the ONECC Study Group [1]. Real-life practice reports with long-term prospective follow-up, out of the scope of clinical trials, help establish a multifaceted evidence base and improve confidence in new approaches and modalities. Pending interim results of a big population-based Danish trial on CCE in colorectal cancer (CRC) screening [2], this study lays out some of the main reasons that prevent CCE from being the primary diagnostic test for the large bowel in cancer screening [3]. Interestingly, in a small, real-life, single-center cohort, using the same laxative-booster combination, we showed that even in younger patients (median age 56 years), CCE could achieve complete colonic examination in only 75 % of cases [4].

In a recent meta-analysis, we demonstrated that low completeness and adequate cleanliness rates (ACRs) torment CCE irrespective of the clinical setting (observational vs randomized clinical trials) [5]. In the same meta-analysis, we established that although polyethylene glycol (PEG) laxative and sodium phosphate (NaP) booster were the most used, they were not associated with higher completion rates or ACRs. In a recent systematic review [6], the use of CCE appeared to be a safe and effective tool for detecting CRC and polyps in a CRC screening setting. Accuracy was comparable to colonoscopy and superior to computed colonography (CTC), making CCE a good alternative to colonoscopy in CRC screening programs, although completion rates require improvement. It is important to note that no significant complication related to CCE was reported in this paper, despite a selected population with many significant comorbidities.

Benech et al. providee a practical patient management algorithm, according to colon capsule endoscopy (CCE) results obtained from the ONECC cohort. This is on par with other published proposals [7] and the realistic medicine guidance suggested by the ScotCap clinical leads collaboration [8]. CCE studies are time-consuming to read and interpret, and human errors are bound to happen [9] [10]. The application so artificial intelligence (AI) to CCE with deep learning convolutional neural network algorithms [11] could lead to automated polyp identification and/or characterisztion with improved sensitivity and reduced time demands by highlighting images with abnormalities for physician review. However, AI will only detect lesions that are already visible; therefore, future research should focus on improving bowel preparation to improve the cleanliness and completeness rate for CCE to the recommended minimum level of 90 % for optical colonoscopy [12].

Competing interests

Dr. Koulaouzidis is co-founder of AJM Med-i-caps; co-director of iCERV Ltd; has received consultancy fees from Jinshan Ltd, received travel support from Jinshan Ltd, Aquilant, and DrFalkPharma; has received research support in the form of a grant from ESGE/Given Imaging Ltd and in the form of material from IntroMedic/SynMed; and has received honoraria from DrFalkPharmaUK, Fering, and Jinshan. He is a member of the advisory board for DrFalkPharma UK, Tillots, and ANKON.

• References

• 1 Benech N, Vinet O, Gaudin J. et al. Colon capsule endoscopy in clinical practice: lessons from a national 5-year observational prospective cohort. Endosc Int Open 2021; 9: E1542-E1548
• 2 Kaalby L, Deding U, Kobaek-Larsen M. et al. Colon capsule endoscopy in colorectal cancer screening: a randomised controlled trial. BMJ Open Gastroenterol 2020; 7: e000411
• 3 Bjørsum-Meyer T, Spada C, Watson AJM. et al. What holds back colon capsule endoscopy from being the main diagnostic test for the large bowel in cancer screening?. Gastrointest Endosc 2021; DOI: 10.1016/j.gie.2021.09.007 .
• 4 Toth E, Yung DE, Nemeth A. et al. Video capsule colonoscopy in routine clinical prctice. Ann Transl Med 2017; 5: 195
• 5 Bjørsum-Meyer T, Skonieczna-Zydecka K, Cortegoso V. et al. Efficacy of bowel preparation regimens for colon capsule endoscopy: a systematic review and meta-analysis. Endosc Int Open 2021; 9: E1658-E1673
• 6 Vuik FER, Nieuwenburg SAV, Moen S. et al. Colon capsule endoscopy in colorectal cancer screening: a systematic review. Endoscopy 2021; 53: 815-824
• 7 Bjørsum-Meyer T, Baatrup G, Koulaouzidis A. colon capsule endoscopy as a diagnostic adjunct in patients with symptoms from the lower gastrointestinal tract. Diagnostics 2021; 11: 1671
• 8 MacLeod C, Mowat C, Winters J. ScotCap clinical leads collaboration. et al. Follow-up of small & diminutive colonic polyps – how to balance the risks in the COVID-19 era. Colorectal Dis 2021; DOI: 10.1111/codi.15907.
• 9 Beg S, Card T, Sidhu R. et al. The impact of reader fatigue on the accuracy of capsule endoscopy interpretation. Dig Liver Dis 2021; 53: 1028-1033
• 10 Koulaouzidis A, Dabos K, Philipper M. et al. How should we do colon capsule endoscopy reading: a practical guide. Ther Adv Gastrointest Endosc 2021; 14 DOI: 10.1177/26317745211001983.
• 11 Robertson AR, Segui S, Wenzek H. et al. Artificial intelligence for the detection of polyps or cancer with colon capsule endoscopy. Ther Adv Gastrointest Endosc 2021; 14 DOI: 10.1177/26317745211020277.
• 12 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397

Publication History

Article published online:
14 March 2022