Colorectal cancer screening with colonoscopy was introduced into the National Cancer Prevention Program in Germany in 2002.
Dr Andreas Sieg and colleagues from Germany hypothesized that as compliance for screening is low, colon capsule endoscopy could be an alternative approach.
Feasibility and performance of colon capsule endoscopy were evaluated in comparison with colonoscopy in ambulatory patients with special attention to a short colon transit time.
The team tested colon capsule endoscopy in ambulatory patients enrolled for colonoscopy who presented for screening or with positive fecal occult blood test.
Study subjects underwent colon preparation and ingested the capsule in the morning.
|The capsule was excreted within 6 hours.|
Colonoscopy was performed after excretion of the capsule.
Colonoscopy and colon capsule endoscopy were performed by independent physicians who were blinded to the results.
The researchers evaluated in total 38 patients.
Only 1 patient was excluded because the capsule remained in the stomach during the entire period of examination.
Another patient had limited time and the procedure had to be stopped when the capsule was still in the transverse colon.
The team reported the results of 36 patients who successfully completed colon capsule endoscopy, and the conventional colonoscopy examination.
The capsule was excreted within 6 hours in 84% of the patients.
If oral sodium phosphate was excluded from the preparation, the colon transit time increased to a median of 8 hours.
The team identified that 7 of 11 small polyps detected by colonoscopy by colon capsule endoscopy.
The research team noted that 1 small polyp detected by colon capsule endoscopy was not identified by colonoscopy.
In this series, no large polyps were found, and 1 colorectal cancer was detected by both methods.
The mean rates of colon cleanliness in the cecum, transverse colon, and in the descending colon were significantly better than in the rectosigmoid colon.
The overall mean rate during colonoscopy was significantly better than during colon capsule endoscopy.
No adverse effects occurred.
Dr Sieg's team concluded, “Colon capsule endoscopy appears to be a promising new modality for colonic evaluation and may increase compliance with colorectal cancer screening.”
“To achieve a short colon transit time, sodium phosphate seems to be a necessary adjunct during preparation.”
“The short transit time is a prerequisite to abandon the delay mode of the capsule.”
“With an un-delayed PillCam COLON capsule, a 'pan-enteric' examination of the gastrointestinal tract would be possible.”
“Further studies are needed to improve the cleanliness, especially in the rectum and to evaluate the method as a potential screening tool.”