From the Guidelines
Colon capsule endoscopy should not be routinely substituted for colonoscopy due to its lower sensitivity and specificity, as well as its inability to perform polypectomy, despite improvements in second-generation colon capsules (CCE-2) 1.
Limitations of Colon Capsule Endoscopy
The limitations of colon capsule endoscopy include lower sensitivity and specificity compared to colonoscopy, with reported sensitivities and specificities for detection of any polyp being 82% and 86%, and for the detection of significant polyps (≥6 mm) being 84%–89% and 64%–88%, respectively 1. Additionally, CCE is limited by its inability to insufflate the colon, aspirate liquids, control the transit of the CCE, and clean the mucosal surface 1.
Comparison with Colonoscopy
Colonoscopy remains the gold standard for polyp characterization due to its ability to provide real-time histological assessment through biopsy, as well as its higher resolution and enhancement technologies for detailed surface pattern and vascular pattern analysis 1.
Appropriate Use of Colon Capsule Endoscopy
CCE may be considered as an alternative for patients who are unwilling or unsuitable for colonoscopy, or in cases where a previous colonoscopy was incomplete 1. The US Food and Drug Administration has approved a CCE for patients after an incomplete optical colonoscopy and for patients with major risks for colonoscopy or moderate sedation 1.
Future Developments
The technology continues to evolve, with improvements in image acquisition and the potential integration of artificial intelligence to improve diagnostic accuracy 1. However, currently, CCE is best used as a screening tool in specific patient populations rather than as a primary method for polyp characterization.
Key Points
- CCE has lower sensitivity and specificity compared to colonoscopy
- CCE is limited by its inability to perform polypectomy and provide real-time histological assessment
- CCE may be considered as an alternative for patients who are unwilling or unsuitable for colonoscopy
- The technology continues to evolve with potential improvements in diagnostic accuracy.
From the Research
Colon Capsule Endoscopy
- Colon capsule endoscopy (CCE) is a minimally invasive, patient-friendly procedure that offers complete visualization of the entire intestine 2.
- CCE has been shown to have acceptable sensitivity and moderate specificity levels in polyp detection, with a per-finding sensitivity of 90.9% and specificity of 67.6% 2.
- The accuracy of CCE in detecting polyp carriers was 81.5% (per-patient analysis) 2.
Polyp Characterization
- CCE detected 43 polyps of any size, while conventional colonoscopy (CC) detected 47 polyps 2.
- The study found that CCE identified esophageal, gastric, and small bowel pathologies in 24%, 38%, and 58% of patients, respectively 2.
- CCE has been approved in Europe as an option for average-risk colorectal cancer screening and high-risk screening in patients with contraindications or unwilling to undergo colonoscopy 3.
Comparison with Other Methods
- CCE has been compared to CT colonography (CTC) following incomplete colonoscopy, with CCE showing a higher diagnostic yield for polyp detection 4.
- CCE completion rate and complete colonic view rate were 76% and 90%, respectively, while CTC completion rate was 98% 4.
- The diagnostic yields of CTC and CCE were 10% and 37% for any size polyps, respectively 4.
Bowel Preparation
- Adequate bowel preparation is essential for thorough visualization of the colon with successful detection of colon polyps 5.
- CCE currently requires a bowel preparation that is more rigorous than colonoscopy 3.
- The use of the Boston Bowel Preparation Scale (BBPS) is recommended for evaluation of cleansing 5.