Comparison of efficiencies of colon capsule endoscopy and optical colonoscopy in patients with a positive immunochemical fecal occult blood test – a multicentre, prospective study

Česká verzia

Authors: Voška M. ¹; Grega T. ¹; Vojtěchová G. ¹; Ngo O. ² ; Májek O. ² ; Bučková B. ²; Ilja Tachecí ³ ; Beneš M. ⁴; Bureš J. ³; Julius Špičák ⁴ ; Zavoral M. ¹; Suchánek Š. ¹
Authors place of work: Interní klinika 1. LF UK a ÚVN – VFN Praha ¹; Institut biostatistiky a analýz, LF MU, Brno ²; II. interní gastroenterologická klinika LF UK a FN Hradec Králové ³; Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha ⁴
Published in the journal: Gastroent Hepatol 2019; 73(5): 398-403
Category: Gastrointestinal Oncology: Original Article
doi: https://doi.org/10.14735/amgh2019398

Summary

Background: Colon capsule endoscopy (CCE) has the potential to become a so-called filter test in individuals with a positive faecal immunochemical test (FIT). The main objective of the study is to determine the negative predictive value of the second generation colonial capsule (CCE2) for polyps ≥ 10 mm.

Material and methods: Since 2016, asymptomatic individuals of screening age with a positive FIT, without an increased risk of colorectal neoplasia, who were examined by CCE2 (independently described by a doctor and a trained nurse) and then immediately by standard optical colonoscopy (OC) have been included in a prospective study in three Czech endoscopic workplaces. The main monitored parameter was the negative predictive value of CCE2 for large polyps (≥ 10 mm), followed by the detection of polyps ≥ 6 mm, ≥ 10 mm, adenomas ≥ 10 mm and carcinomas, intestinal preparation level, examination tolerance, and CCE complications.

Results: So far, 248 individuals have been enrolled, and the data from 178 individuals with full results have been analyzed. OC polyps were diagnosed in 144 persons (81%), of whom 90 (51%) and 47 (26%) had polyps ≥ 6 mm and ≥ 10 mm, resp. The sensitivities of CCE2 for polyps ≥ 6 mm and ≥ 10 mm were 82% (95% confidence interval [CI]: 73–89%) and 79% (95% CI: 64–89%), respectively. The specificities for polyps ≥ 6 mm and ≥ 10 mm reached 85% (95% CI: 76–92%) and 92% (95% CI: 86–96%), respectively. The negative predictive value of CCE2 for polyps ≥ 10 mm was 92% (95% CI: 86–96%). Nurses identified 73 polyps ≥ 6 mm in 90 individuals (83%) and 37 polyps ≥ 10 mm in 47 (79%) by OC. A total of 119 patients (66%) preferred CCE2 as the primary screening method.

Conclusion: CCE2 achieves a high negative predictive value for large polyps. It is a well-accepted method with the potential of becoming a filter test in individuals with a positive FIT.

Keywords:

colorectal cancer – adenoma – colonic capsule – optic colonoscopy – fecal immunochemical tests

Zdroje

1. Dušek L, Mužík J, Pavlík T et al. Epidemiologie zhoubných nádorů trávicího traktu v České republice – současný stav a predikce. Gastroent Hepatol 2012; 66 (5): 331–339.

2. Zavoral M, Suchánek Š, Májek O et al. Národní program screeningu kolorektálního karcinomu v České republice – minulost, přítomnost a budoucnost. Gastroent Hepatol 2012; 66 (5): 345–349.

3. European Colorectal Cancer Screening Guidelines Working Group, von Karsa L, Parnick J et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication. Endoscopy 2013; 45 (1): 51–59. doi: 10.1055/s-0032-1325997.

4. Spada C, Riccioni ME, Hassan C et al. PillCam colon capsule endoscopy: a prospective, randomized trial comparing two regimens of preparation. J Clin Gastroenterol 2011; 45 (2): 119–124. doi: 10.1097/MCG.0b013e3181dac04b.

5. Spada C, Hassan C, Galmiche JP et al. Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2012; 44 (5): 527–536. doi: 10.1055/s-0031-1291717.

6. Kastenberg D, Burch WC, Romeo DP et al. Multicenter, randomized study to optimize bowel preparation for colon capsule endosocpy. World J Gastroenterol 2017; 23 (48): 8615–8625. doi: 10.3748/wjg. v23.i48.8615.

7. Kaminski MF, Regula J, Kraszewska E et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362 (19): 1795–1803. doi: 10.1056/NEJMoa0907 667.

8. Eliakim R, Fireman Z, Gralnek IM et al. Evaluation of the PillCam Colon capsule in the detection of colonic pathology: results of the first multicenter, prospective, comparative study. Endoscopy 2006; 38 (10): 963−970. doi: 10.1055/s-2006-944832.

9. Van Gossum A, Munoz-Navas M, Fernandez-Urien I et al. Capsule endoscopy versus colonoscopy for the detection of polyps and cancer. N Engl J Med 2009; 361 (3): 264–270. doi: 10.1056/NEJMoa0806347.

10. Eliakim R, Yassin K, Niv Y et al. Prospective multicenter performance evaluation of the second-generation colon capsule compared with colonoscopy. Endoscopy 2009; 41 (12): 1026–1031. doi: 10.1055/s-0029-1215360.

11. Spada C, Hassan C, Munoz-Navas M et al. Second-generation colon capsule endoscopy compared with colonoscopy. Gastrointest Endosc 2011; 74 (3): 581–589. doi: 10.1016/j.gie.2011.03.1125.

12. Rex DK, Adler SN, Aisenberg J et al. Accuracy of capsule colonoscopy in detecting colorectal polyps in a screening population. Gastroenterology 2015; 148 (5): 948–957. doi: 10.1053/j.gastro.2015.01.025.

13. Voska M, Zavoral M, Grega T et al. Accuracy of colon capsule endoscopy for colorectal neoplasia detection in individuals referred for a screening colonoscopy. Gastroenterology Res Pract 2019. 5975438. doi: 10.1155/2019/5975 438.

14. Rezapour M, Amadi C, Gerson LB et al. Retention associated with video capsule endoscopy: systematic review and meta-analysis. Gastrointest Endosc 2017; 85 (6): 1157–1168. doi: 10.1016/j.gie.2016.12.024.