1
|
Liao Z, Guo JT, Yang F, Wang SP, Sun SY. Screening of colorectal cancer: Methods and strategies. World J Clin Oncol 2024; 15:799-805. [PMID: 39071460 PMCID: PMC11271723 DOI: 10.5306/wjco.v15.i7.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/14/2024] [Accepted: 05/27/2024] [Indexed: 07/16/2024] Open
Abstract
Colorectal cancer (CRC) has high incidence and mortality rates, and the emergence and application of CRC screening have helped us effectively control the occurrence and development of CRC. Currently, common international screening methods include tests based on feces and blood, and examination methods that allow for visualization, such as sigmoidoscopy and colonoscopy. Some methods have been widely used, whereas others such as multi-target stool RNA test are still being explored and developed, and are expected to become front-line screening methods for CRC in the future. The choice of screening method is affected by external conditions and the patients' situation, and the clinician must choose an appropriate strategy according to the actual situation and the patient's wishes. This article introduces various CRC screening methods and analyzes the factors relevant to the screening strategy.
Collapse
Affiliation(s)
- Zhen Liao
- Department of Gastroenterology, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Jin-Tao Guo
- Department of Gastroenterology, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Fan Yang
- Department of Gastroenterology, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Shu-Peng Wang
- Department of Gastroenterology, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Si-Yu Sun
- Department of Gastroenterology, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| |
Collapse
|
2
|
Omori T, Jodai Y, Maeda K, Ohmiya N. Prospective study of diagnostic yields of flexible spectral imaging color enhancement installed in colon capsule endoscopy for colorectal polyps and tumors. Gastrointest Endosc 2024; 99:245-253.e2. [PMID: 37797727 DOI: 10.1016/j.gie.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 08/19/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND AIMS We prospectively determined the efficacy of flexible spectral imaging color enhancement (FICE) used with second-generation colon capsule endoscopy (CCE) for colorectal polyps and tumors (CRTs). METHODS This study included optical colonoscopy within 4 months after CCE. Two colonoscopists independently reviewed CCE using white-light images (CCE-WL) and CCE using FICE images (CCE-FICE), respectively. Based on colonoscopic findings as the criterion standard, the diagnostic accuracy for CRTs was compared between CCE-WL and CCE-FICE. RESULTS Of 89 enrolled patients (65 men and 24 women; 75 with CRTs including 36 with serrated lesions, 63 with adenomas, and 9 with adenocarcinomas), the per-patient detectability of CCE-FICE for the representative CRTs was significantly higher than that of CCE-WL: overall CRTs (CCE-WL, 79%; CCE-FICE, 88%; P = .0001), 6- to 9-mm CRTs (CCE-WL, 63%; CCE-FICE, 94%; P = .0055), and ≥6-mm CRTs (CCE-WL, 78%; CCE-FICE, 93%; P = .0159). The per-lesion sensitivity of CCE-FICE was significantly higher than that of CCE-WL for CRTs: overall (CCE-WL, 61%; CCE-FICE, 79%; P < .0001), <6 mm (CCE-WL, 53%; CCE-FICE, 69%; P < .0001), 6- to 9-mm CRTs (CCE-WL, 65%; CCE-FICE, 93%; P = .0007), slightly elevated CRTs (CCE-WL, 53%; CCE-FICE, 75%; P < .0001), tubular adenomas (CCE-WL, 61%; CCE-FICE, 79%; P < .0001), and serrated polyps (CCE-WL, 57%; CCE-FICE, 74%; P = .0022). Both modes detected all adenocarcinomas. No significant differences were found between CCE-WL and CCE-FICE of the per-lesion sensitivity for ≥10-mm CRTs (CCE-WL, 81%; CCE-FICE, 94%; P = .1138) or protruding CRTs (CCE-WL, 77%; CCE-FICE, 86%; P = .0614). Kappa coefficients for overall CRTs for CCE-WL and CCE-FICE were .66 and .64, respectively, which indicated substantial agreement. CONCLUSIONS CCE-FICE improved the detection rates for all CRTs except adenocarcinomas, ≥10-mm polyps, and protruding polyps when compared with CCE-WL. (Clinical trial registration number: UMIN 000021125.).
Collapse
Affiliation(s)
- Takafumi Omori
- Department of Gastroenterology, Fujita Health University, Toyoake, Japan
| | - Yasutaka Jodai
- Department of Gastroenterology, Fujita Health University, Toyoake, Japan
| | - Kohei Maeda
- Department of Gastroenterology, Fujita Health University, Toyoake, Japan
| | - Naoki Ohmiya
- Department of Gastroenterology, Fujita Health University, Toyoake, Japan; Department of Advanced Endoscopy, Fujita Health University, Toyoake, Japan
| |
Collapse
|
3
|
Wu W, Tan S, Huang J, Chen Y, Wong MCS, Xu W. A qualitative interview study on colorectal cancer screening in China. Front Med (Lausanne) 2024; 11:1232134. [PMID: 38357645 PMCID: PMC10864664 DOI: 10.3389/fmed.2024.1232134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Background The effectiveness of triage screening for colorectal cancer (CRC) is not fully achieved in Chinese populations, mainly due to low compliance to colonoscopy follow-up. This study aimed to collect viewpoints of experts in China on ongoing screening programs and emerging screening tests for CRC, which may help to improve effectiveness of CRC screening in the country. Methods We conducted 15 semi-structured interviews with experts involving CRC screening in China during October to November of 2020. Interview topics included personal characteristics, work context, opinions on ongoing screening programs, challenges and opportunities in optimization of screening strategies, and prospects for CRC screening in near future. To analyze the data, we used a generic qualitative research approach inspired by grounded theory, including open, axial, and selective coding. Results This analysis revealed a total of 83 initial categories, 37 subcategories and 10 main categories, which included 4 core categories of current modality for CRC screening, factors influencing screening effectiveness, optimization of CRC screening modality, and prospects for development of CRC screening. The results provide insight into the factors underlying the challenges of the ongoing CRC screening programs in China: the most important concern is the low compliance to colonoscopy, followed by the low specificity of the currently-used initial tests. The experts proposed to use quantitative instead of qualitative fecal immunochemical test (FIT), and optimize risk assessment tools to improve specificity of initial tests. Regarding the emerging screening tests, 9 of 15 experts did not think that the novel techniques are good enough to replace the current tests, but can be used complementarily in opportunistic screening for CRC. Conclusion The viewpoints of Chinese experts suggested that use quantitative FIT or optimize risk assessment tools may help to identify high-risk individuals of CRC more accurately, improve adherence to colonoscopy, and thus fully achieve the effectiveness of screening.
Collapse
Affiliation(s)
- Weimiao Wu
- Global Health Institute, Fudan University School of Public Health, Shanghai, China
| | - Songsong Tan
- Global Health Institute, Fudan University School of Public Health, Shanghai, China
| | - Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Yingyao Chen
- Global Health Institute, Fudan University School of Public Health, Shanghai, China
| | - Martin C. S. Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wanghong Xu
- Global Health Institute, Fudan University School of Public Health, Shanghai, China
| |
Collapse
|
4
|
Tonini V, Zanni M. Why is early detection of colon cancer still not possible in 2023? World J Gastroenterol 2024; 30:211-224. [PMID: 38314134 PMCID: PMC10835528 DOI: 10.3748/wjg.v30.i3.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/30/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024] Open
Abstract
Colorectal cancer (CRC) screening is a fundamental tool in the prevention and early detection of one of the most prevalent and lethal cancers. Over the years, screening, particularly in those settings where it is well organized, has succeeded in reducing the incidence of colon and rectal cancer and improving the prognosis related to them. Despite considerable advancements in screening technologies and strategies, the effectiveness of CRC screening programs remains less than optimal. This paper examined the multifaceted reasons behind the persistent lack of effectiveness in CRC screening initiatives. Through a critical analysis of current methodologies, technological limitations, patient-related factors, and systemic challenges, we elucidated the complex interplay that hampers the successful reduction of CRC morbidity and mortality rates. While acknowledging the advancements that have improved aspects of screening, we emphasized the necessity of addressing the identified barriers comprehensively. This study aimed to raise awareness of how important CRC screening is in reducing costs for this disease. Screening and early diagnosis are not only important in improving the prognosis of patients with CRC but can lead to an important reduction in the cost of treating a disease that is often diagnosed at an advanced stage. Spending more sooner can mean saving money later.
Collapse
Affiliation(s)
- Valeria Tonini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Italy
| | - Manuel Zanni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Italy
| |
Collapse
|
5
|
Rosa B, Donato H, Cúrdia Gonçalves T, Sousa-Pinto B, Cotter J. What Is the Optimal Bowel Preparation for Capsule Colonoscopy and Pan-intestinal Capsule Endoscopy? A Systematic Review and Meta-Analysis. Dig Dis Sci 2023; 68:4418-4431. [PMID: 37833441 PMCID: PMC10635919 DOI: 10.1007/s10620-023-08133-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND The rate of adequate cleansing (ACR) and complete examinations (CR) are key quality indicators in capsule colonoscopy (CC) and pan-intestinal capsule endoscopy (PCE). AIMS To evaluate the efficacy of bowel preparation protocols regarding ACR and CR. METHODS We conducted a systematic review and meta-analysis, search terms regarding colon capsule preparation, publication date from 2006/01, and date of search 2021/12, in six bibliographic databases. Multiple steps of the cleansing protocol were assessed: diet, adjunctive laxatives, purgative solution, use of prokinetic agents, and "booster". The meta-analytical frequency of ACR and CR was estimated, and subgroup analyses performed. Strategies associated with higher ACR and CR were explored using meta-analytical univariable and multivariable regression models. RESULTS Twenty-six observational studies and five RCTs included (n = 4072 patients). The pooled rate of ACR was 72.5% (95% C.I. 67.8-77.5%; I2 = 92.4%), and the pooled rate of CR was 83.0% (95% C.I. 78.7-87.7%; I2 = 96.5%). The highest ACR were obtained using a low-fibre diet [78.5% (95% C.I. 72.0-85.6%); I2 = 57.0%], adjunctive laxatives [74.7% (95% C.I. 69.8-80.1%); I2 = 85.3%], and split dose < 4L polyethylene glycol (PEG) as purgative [77.5% (95% C.I. 68.4-87.8%); I2 = 47.3%]. The highest CR were observed using routine prokinetics prior to capsule ingestion [84.4% (95% C.I. 79.9-89.2%); I2 = 89.8%], and sodium phosphate (NaP) as "booster" [86.2% (95% C.I. 82.3-90.2%); I2 = 86.8%]. In univariable models, adjunctive laxatives were associated with higher ACR [OR 1.81 (95% C.I. 1.13; 2.90); p = 0.014]. CR was higher with routine prokinetics [OR 1.86 (95% C.I. 1.13; 3.05); p = 0.015] and split-dose PEG purgative [OR 2.03 (95% C.I. 1.01; 4.09), p = 0.048]. CONCLUSIONS Main quality outcomes (ACR, CR) remain suboptimal for CC and PCE. Despite considerable heterogeneity, our results support low-fibre diet, use of adjunctive sennosides, split dose < 4L PEG, and routine prokinetics, while NaP remains the most consistent option as booster.
Collapse
Affiliation(s)
- Bruno Rosa
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Guimarães, Portugal.
- School of Medicine, Life and Health Sciences Research Institute, University of Minho, Braga, Guimarães, Portugal.
- ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal.
| | - Helena Donato
- Documentation and Scientific Information Service, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Tiago Cúrdia Gonçalves
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Guimarães, Portugal
- School of Medicine, Life and Health Sciences Research Institute, University of Minho, Braga, Guimarães, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Bernardo Sousa-Pinto
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - José Cotter
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Guimarães, Portugal
- School of Medicine, Life and Health Sciences Research Institute, University of Minho, Braga, Guimarães, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal
| |
Collapse
|
6
|
Chiu LS, Calderwood AH. Noninvasive Colorectal Cancer Prevention Options in Older Adults. J Clin Gastroenterol 2023; 57:855-862. [PMID: 37436836 DOI: 10.1097/mcg.0000000000001893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Colorectal cancer (CRC) is a leading cause of morbidity and mortality worldwide and its incidence increases with age. The proportion of older adults in the United States continues to rise, making CRC prevention a key health priority for our aging population. CRC is a largely preventable disease through screening and polyp surveillance, and noninvasive modalities represent an important option for older adults in whom the burdens and risks of invasive testing are higher compared with younger adults. This review highlights the evidence, risks, and benefits of noninvasive CRC screening and surveillance options in older adults and discusses the challenges of CRC prevention in this cohort.
Collapse
Affiliation(s)
- Laura S Chiu
- Department of Medicine, Section of Gastroenterology, Boston University School of Medicine, Boston, MA
| | - Audrey H Calderwood
- Department of Medicine, Section of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| |
Collapse
|
7
|
Tai FWD, McAlindon M, Sidhu R. Colon Capsule Endoscopy - Shining the Light through the Colon. Curr Gastroenterol Rep 2023; 25:99-105. [PMID: 37022665 DOI: 10.1007/s11894-023-00867-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE OF REVIEW Colon capsule endoscopy (CCE) is a non-invasive, wireless capsule endoscope. In this article, we review its current applications, compare its performance with optical colonoscopy (OC) and alternative imaging modalities like CT colonography (CTC), and highlight developments that may increase potential future use. RECENT FINDINGS By comparison to OC both CCE and CTC have a good sensitivity and specificity in detecting colonic polyps. CCE is more sensitive in detecting sub centimetre polyps. CCE is capable of detecting colonic inflammation and anorectal pathologies, commonly missed by CTC. However, rates of complete CCE examinations are limited by inadequate bowel preparation or incomplete colonic transit, whereas CTC can be performed with less bowel purgatives. Patients tolerate CCE better than OC, however patient preference between CCE and CTC vary. CCE and CTC are both reasonable alternatives to OC. Strategies to improve completion rates and adequacy of bowel preparation will improve cost and clinical effectiveness of CCE.
Collapse
Affiliation(s)
- Foong Way David Tai
- Academic Unit of Gastroenterology, Room P13, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop Road, Sheffield, UK.
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
| | - Mark McAlindon
- Academic Unit of Gastroenterology, Room P13, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop Road, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Reena Sidhu
- Academic Unit of Gastroenterology, Room P13, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop Road, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| |
Collapse
|
8
|
Semenov S, Costigan C, Ismail MS, McNamara D. Low Colon Capsule Endoscopy (CCE) False Negative Rate for Polyps Excluding Reader Error. Diagnostics (Basel) 2022; 13:diagnostics13010056. [PMID: 36611348 PMCID: PMC9818729 DOI: 10.3390/diagnostics13010056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND CCE is a diagnostic tool lacking clinical data on false negative rates. We aimed to assess this rate and the reader/technical error breakdown. METHODS False negative CCEs were identified after comparing to a colonoscopy database. Missed pathology characteristics and study indications/quality were collated. Cases were re-read by experts and newly identified lesions/pathologies were verified by an expert panel and categorised as reader/technical errors. RESULTS Of 532 CCEs, 203 had an adequately reported comparative colonoscopy, 45 (22.2%) had missed polyps, and 26/45 (57.8%) reached the colonic section with missed pathology. Of the cases, 22 (84.6%) had adequate bowel preparation. Indications included 13 (50%) polyp surveillance, 12 (46%) GI symptoms, 1 (4%) polyp screening. CCE missed 18 (69.2%) diminutive polyps and 8 (30.8%) polyps ≥ 6 mm, 18/26 (69.2%) of these were adenomas. Excluding incomplete CCE correlates, colonoscopy total and significant polyp yield were 97/184 (52.7%) and 50/97 (51.5%), respectively. CCE total polyp and significant polyp false negative rate was 26.8% (26/97) and 16% (8/50), respectively. Following re-reading, reader and technical error was 20/26 (76.9%) and 6/26 (23.1%). Total and significant missed polyp rates were 20.6% (20/97) and 14% (7/50) for reader error, 6.2% (6/97) and 2% (1/50) for technical error. CONCLUSIONS False negative CCE rate is not insubstantial and should be factored into clinical decision making.
Collapse
Affiliation(s)
- Serhiy Semenov
- Trinity Academic Gastroenterology Group, Trinity Centre, Tallaght Hospital, Trinity College Dublin, D02 R590 Dublin, Ireland
- Correspondence:
| | - Conor Costigan
- Trinity Academic Gastroenterology Group, Trinity Centre, Tallaght Hospital, Trinity College Dublin, D02 R590 Dublin, Ireland
- Department of Gastroenterology, Tallaght University Hospital, D24 NR0A Dublin, Ireland
| | - Mohd Syafiq Ismail
- Trinity Academic Gastroenterology Group, Trinity Centre, Tallaght Hospital, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Deirdre McNamara
- Trinity Academic Gastroenterology Group, Trinity Centre, Tallaght Hospital, Trinity College Dublin, D02 R590 Dublin, Ireland
- Department of Gastroenterology, Tallaght University Hospital, D24 NR0A Dublin, Ireland
| |
Collapse
|
9
|
The Effectiveness of a Very Low-Volume Compared to High-Volume Laxative in Colon Capsule Endoscopy. Diagnostics (Basel) 2022; 13:diagnostics13010018. [PMID: 36611310 PMCID: PMC9818960 DOI: 10.3390/diagnostics13010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Colon capsule endoscopy (CCE) is a promising modality for colonic investigations, but completion rates (CR) and adequate cleansing rates (ACR) must be improved to meet established standards for optical colonoscopy. Improvements should be made with patient acceptability in mind. We aimed to compare a very low-volume polyethylene glycol (PEG) laxative to a conventional high-volume laxative. We carried out a single-center retrospective comparative cohort study including patients referred for CCE. One hundred and sixty-six patients were included in the final analysis, with eighty-three patients in each group. We found a CR and ACR of 77% and 67% in the high-volume group and 72% and 75% in the very low-volume group, respectively. In the high-volume group, 54% had complete transit and adequate cleansing, whereas this was the case for 63% in the very low-volume group. No statistically significant difference in CR, ACR, or a combination of the two was found. A very low-volume bowel preparation regimen was non-inferior to a high-volume regimen before CCE in terms of CR and ACR.
Collapse
|
10
|
Colon Capsule Endoscopy in the Diagnosis of Colon Polyps: Who Needs a Colonoscopy? Diagnostics (Basel) 2022; 12:diagnostics12092093. [PMID: 36140494 PMCID: PMC9498104 DOI: 10.3390/diagnostics12092093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 12/09/2022] Open
Abstract
Colon screening programs have reduced colon cancer mortality. Population screening should be minimally invasive, safe, acceptably sensitive, cost-effective, and scalable. The range of screening modalities include guaiac or immunochemical fecal occult blood testing and CT colonography and colonoscopy. A number of carefully controlled studies concur that second-generation capsule endoscopy has excellent sensitivity for polyp detection and a high negative predictive value. Colon capsules fulfill the screening expectation of safety, high sensitivity for polyp detection, and patient acceptance, and appear to straddle the divide between occult blood testing and colonoscopy. While meeting these criteria, there remains the challenges of scaling, capsule practitioner training, resource allocation, and implementing change of practice. Like CT colonography, capsule screening presents the clinician with a decision on the threshold for colonoscopy referral. Overall, colon capsules are an invaluable tool in polyp detection and colon screening and offer a filter that determines “who needs a colonoscopy?”.
Collapse
|
11
|
Jain S, Maque J, Galoosian A, Osuna-Garcia A, May FP. Optimal Strategies for Colorectal Cancer Screening. Curr Treat Options Oncol 2022; 23:474-493. [PMID: 35316477 PMCID: PMC8989803 DOI: 10.1007/s11864-022-00962-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/12/2022]
Abstract
OPINION STATEMENT Colorectal cancer (CRC) imposes significant morbidity and mortality, yet it is also largely preventable with evidence-based screening strategies. In May 2021, the US Preventive Services Task Force updated guidance, recommending screening begin at age 45 for average-risk individuals to reduce CRC incidence and mortality in the United States (US). The Task Force recommends screening with one of several screening strategies: high-sensitivity guaiac fecal occult blood test (HSgFOBT), fecal immunochemical test (FIT), multi-target stool DNA (mt-sDNA) test, computed tomographic (CT) colonography (virtual colonoscopy), flexible sigmoidoscopy, flexible sigmoidoscopy with FIT, or traditional colonoscopy. In addition to these recommended options, there are several emerging and novel CRC screening modalities that are not yet approved for first-line screening in average-risk individuals. These include blood-based screening or "liquid biopsy," colon capsule endoscopy, urinary metabolomics, and stool-based microbiome testing for the detection of colorectal polyps and/or CRC. In order to maximize CRC screening uptake in the US, patients and providers should engage in informed decision-making about the benefits and limitations of recommended screening options to determine the most appropriate screening test. Factors to consider include the invasiveness of the test, test performance, screening interval, accessibility, and cost. In addition, health systems should have a programmatic approach to CRC screening, which may include evidence-based strategies such as patient education, provider education, mailed screening outreach, and/or patient navigation, to maximize screening participation.
Collapse
Affiliation(s)
- Shailavi Jain
- Department of Medicine, David Geffen School of Medicine, UCLA Ronald Reagan Medical Center, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095 USA
| | - Jetrina Maque
- Department of Medicine, David Geffen School of Medicine, UCLA Ronald Reagan Medical Center, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095 USA
| | - Artin Galoosian
- Department of Medicine, David Geffen School of Medicine, UCLA Ronald Reagan Medical Center, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095 USA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 S. Charles E Young Drive, Center for Health Sciences, Suite A2-125, Los Angeles, CA 90095-6900 USA
| | - Antonia Osuna-Garcia
- Louise M. Darling Biomedical Library, University of California, Los Angeles, Center for Health Sciences, 12-077, Los Angeles, CA 90095-1798 USA
| | - Folasade P. May
- Department of Medicine, David Geffen School of Medicine, UCLA Ronald Reagan Medical Center, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095 USA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 S. Charles E Young Drive, Center for Health Sciences, Suite A2-125, Los Angeles, CA 90095-6900 USA
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA USA
- UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, 650 S. Charles E Young Drive, Center for Health Sciences, Suite A2-125, Los Angeles, CA 90095-6900 USA
| |
Collapse
|
12
|
Sulbaran M, Bustamante-Lopez L, Bernardo W, Sakai CM, Sakai P, Nahas S, Moura EGHD. Systematic review and meta-analysis of colon capsule endoscopy accuracy for colorectal cancer screening. An alternative during the Covid-19 pandemic? J Med Screen 2022; 29:148-155. [PMID: 35068246 PMCID: PMC9382578 DOI: 10.1177/09691413221074803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Aim To determine the diagnostic accuracy of colon capsule endoscopy for colorectal cancer screening. Methods Studies that compared the diagnostic performance of colonoscopy and second-generation colon capsule endoscopy (CCE-2) for screening of asymptomatic patients aged 50–75 years were included. The primary outcomes were sensitivity, specificity, and positive and negative likelihood ratios for polyps and adenomas measuring at least 6 mm or 10 mm. Results Eight full-text studies that evaluated 1602 patients were included for systematic review. Of these, 840 (52.43%) patients participated in an opportunistic screening program. The pooled outcomes of CCE-2 for polyps at least 6 mm / 10 mm were (CI = confidence interval): sensitivity: 88% (95% CI: 0.84–0.91) / 88% (95% CI: 0.82–0.93), specificity: 94% (95% CI: 0.92–0.95) / 95.5% (95% CI: 0.94–0.97); positive likelihood ratio: 11.86 (95% CI: 5.53–25.46) / 23.07 (95% CI: 6.163–86.36); negative likelihood ratio: 0.14 (95% CI: 0.1–0.21) / 0.14 (95% CI: 0.09–0.21). The area under the summary receiver operating characteristic curve for polyps at least 6 and 10 mm was 96.3% and 96.7%, respectively. The only cancer missed by complete CCE-2 was shown at multiple frames in the unblinded review. In total, 125 (7.8%) patients presented mild adverse events mostly related to bowel preparation. Conclusion CCE-2 is demonstrated to be an effective and safe alternative method for colorectal cancer screening. Diagnostic performance of CCE-2 for polyps of at least 6 and 10 mm was similar. Completion rates still need to be improved.
Collapse
Affiliation(s)
- Marianny Sulbaran
- Gastrointestinal Department, Hospital das Clinicas, Sao Paulo University School of Medicine, Sao Paulo, Brazil
| | - Leonardo Bustamante-Lopez
- Gastrointestinal Department, Hospital das Clinicas, Sao Paulo University School of Medicine, Sao Paulo, Brazil
- Surgical Health Outcomes Consortium (SHOC), Digestive Health and Surgery Institute, AdventHealth, Orlando, USA
| | - Wanderley Bernardo
- Gastrointestinal Department, Hospital das Clinicas, Sao Paulo University School of Medicine, Sao Paulo, Brazil
| | - Christiano M. Sakai
- Gastrointestinal Department, Hospital das Clinicas, Sao Paulo University School of Medicine, Sao Paulo, Brazil
| | - Paulo Sakai
- Gastrointestinal Department, Hospital das Clinicas, Sao Paulo University School of Medicine, Sao Paulo, Brazil
| | - Sergio Nahas
- Gastrointestinal Department, Hospital das Clinicas, Sao Paulo University School of Medicine, Sao Paulo, Brazil
| | - Eduardo G H de Moura
- Gastrointestinal Department, Hospital das Clinicas, Sao Paulo University School of Medicine, Sao Paulo, Brazil
| |
Collapse
|
13
|
Moen S, Vuik FER, Voortman T, Kuipers EJ, Spaander MCW. Predictors of Gastrointestinal Transit Times in Colon Capsule Endoscopy. Clin Transl Gastroenterol 2022; 13:e00498. [PMID: 35584543 PMCID: PMC9236601 DOI: 10.14309/ctg.0000000000000498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/22/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Optimizing the accuracy of colon capsule endoscopy (CCE) requires high completion rates. To prevent incomplete CCE, we aimed to identify predictors associated with slow CCE transit times. METHODS In this population-based study, participants received CCE with a split-dose polyethylene glycol bowel preparation and booster regimen (0.5 L oral sulfate solution and 10 mg metoclopramide if capsule remained in stomach for > 1 hour). The following predictors were assessed: age, sex, body mass index (BMI), smoking, coffee and fiber intake, diet quality, physical activity, dyspeptic complaints, stool pattern, history of abdominal surgery, medication use, and CCE findings. Multivariable logistic and linear regressions with backward elimination were performed. RESULTS We analyzed 451 CCE procedures with a completion rate of 51.9%. The completion rate was higher among older participants (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.04-2.28, P = 0.03) and participants with a changed stool pattern (OR 2.27, 95% CI 1.20-4.30, P = 0.01). Participants with a history of abdominal surgery had a lower completion rate (OR 0.54, 95% CI 0.36-0.80, P = 0.003). Participants with higher BMI had faster stomach, small bowel, and total transit times (β = -0.10, P = 0.01; β = -0.14, P = 0.001; β = -0.12, P = 0.01). A faster small bowel transit was found in participants with a changed stool pattern (β = -0.08, P = 0.049) and the use of metoclopramide (β = -0.14, P = 0.001). Participants with high fiber intake had a slower colonic transit (β = 0.11, P = 0.03). DISCUSSION Younger age, unchanged stool pattern, history of abdominal surgery, low BMI, and high fiber intake resulted in slower CCE transit times and lower completion rates. In future practice, these factors can be considered to adjust preparation protocols.
Collapse
Affiliation(s)
- Sarah Moen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Fanny E. R. Vuik
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
| | - Ernst J. Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Manon C. W. Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
14
|
Gimeno-García AZ, González-Suárez B, de Ganzo ZA, Fernández OA, Ramos L, Giordano A, Carretero C, Jiménez A, Nicolás D, Guerra MH, Quintero E. Factores predictores de limpieza colónica inadecuada en exploraciones con cápsula endoscópica de colon. GASTROENTEROLOGIA Y HEPATOLOGIA 2022; 45:605-613. [PMID: 35065169 DOI: 10.1016/j.gastrohep.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/18/2021] [Accepted: 01/05/2022] [Indexed: 11/26/2022]
|
15
|
Abstract
Despite strong evidence of effectiveness, colorectal cancer (CRC) screening remains underused. Currently, there are several options for CRC screening, each with its own performance characteristics and considerations for practice. This Review aims to cover current CRC screening guidelines and highlight future blood-based and imaging-based options for screening. In current practice, the leading non-invasive option is the faecal immunochemical test (FIT) based on its high specificity, good sensitivity, low cost and ease of use in mailed outreach programmes. There are currently five blood-based CRC screening tests in varying stages of evaluation, including one that is currently sold in the USA as a laboratory-developed test. There are ongoing studies on the diagnostic accuracy and longitudinal performance of blood tests and they have the potential to disrupt the CRC screening landscape. Imaging-based options, including the colon capsule, MR colonography and the CT capsule, are also being tested in active studies. As the world attempts to recover from the COVID-19 pandemic and adapts to the start of CRC screening among people at average risk starting at age 45 years, non-invasive options will become increasingly important.
Collapse
|
16
|
Vuik FE, Moen S, Nieuwenburg SA, Schreuders EH, Kuipers EJ, Spaander MC. Applicability of colon capsule endoscopy as pan-endoscopy: From bowel preparation, transit, and rating times to completion rate and patient acceptance. Endosc Int Open 2021; 9:E1852-E1859. [PMID: 34917449 PMCID: PMC8670994 DOI: 10.1055/a-1578-1800] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/02/2021] [Indexed: 12/11/2022] Open
Abstract
Background and study aims Colon capsule endoscopy (CCE) has the potential to explore the entire gastrointestinal tract. The aim of this study was to assess the applicability of CCE as pan-endoscopy. Patients and methods Healthy participants received CCE with bowel preparation (bisacodyl, polyethylene electrolyte glycol (PEG) + ascorbic acid) and booster regimen (metoclopramide, oral sulfate solution (OSS)). For each segment of the gastrointestinal tract, the following quality parameters were assessed: cleanliness, transit times, reading times, patient acceptance and safety of the procedure. When all gastrointestinal segments had cleansing score good or excellent, cleanliness of the whole gastrointestinal tract was assessed as good. Participants' expected and perceived burden was assessed by questionnaires and participants were asked to grade the procedure (scale 0-10). All serious adverse events (SAEs) were documented. Results A total of 451 CCE procedures were analyzed. A good cleansing score was achieved in the stomach in 69.6%, in the SB in 99.1 % and in the colon in 76.6 %. Cleanliness of the whole gastrointestinal tract was good in 52.8 % of the participants. CCE median transit time of the whole gastrointestinal tract was 583 minutes IQR 303-659). The capsule reached the descending colon in 94.7 %. Median reading time per procedure was 70 minutes (IQR 57-83). Participants graded the procedure with a 7.8. There were no procedure-related SAEs. Conclusions CCE as pan-endoscopy has shown to be a safe procedure with good patient acceptance. When cleanliness of all gastrointestinal segments per patient, completion rate and reading time will be improved, CCE can be applied as a good non-invasive alternative to evaluate the gastrointestinal tract.
Collapse
Affiliation(s)
- Fanny E.R. Vuik
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Sarah Moen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Stella A.V. Nieuwenburg
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Eline H. Schreuders
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Ernst J. Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Manon C.W. Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
17
|
Bjoersum-Meyer T, Skonieczna-Zydecka K, Cortegoso Valdivia P, Stenfors I, Lyutakov I, Rondonotti E, Pennazio M, Marlicz W, Baatrup G, Koulaouzidis A, Toth E. Efficacy of bowel preparation regimens for colon capsule endoscopy: a systematic review and meta-analysis. Endosc Int Open 2021; 9:E1658-E1673. [PMID: 34790528 PMCID: PMC8589531 DOI: 10.1055/a-1529-5814] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/04/2021] [Indexed: 12/11/2022] Open
Abstract
Background and study aims Colon capsule endoscopy (CCE) is an alternative to conventional colonoscopy (CC) in specific clinical settings. High completion rates (CRs) and adequate cleanliness rates (ACRs) are fundamental quality parameters if CCE is to be widely implemented as a CC equivalent diagnostic modality. We conducted a systematic review and meta-analysis to investigate the efficacy of different bowel preparations regimens on CR and ACR in CCE. Patients and methods We performed a systematic literature search in PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library. Data were independently extracted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The primary outcome measures (CR, ACR) were retrieved from the individual studies and pooled event rates were calculated. Results Thirty-four observational (OBS) studies (n = 3,789) and 12 randomized clinical trials (RCTs) (n = 1,214) comprising a total 5,003 patients were included. The overall CR was 0.798 (95 % CI, 0.764-0.828); the highest CRs were observed with sodium phosphate (NaP) + gastrografin booster (n = 2, CR = 0.931, 95 % CI, 0.820-0.976). The overall ACR was 0.768 (95 % CI, 0.735-0.797); the highest ACRs were observed with polyethylene glycol (PEG) + magnesium citrate (n = 4, ER = 0.953, 95 % CI, 0.896-0.979). Conclusions In the largest meta-analysis on CCE bowel preparation regimens, we found that both CRs and ACRs are suboptimal compared to the minimum recommended standards for CC. PEG laxative and NaP booster were the most commonly used but were not associated with higher CRs or ACRs. Well-designed studies on CCE should be performed to find the optimal preparation regimen.
Collapse
Affiliation(s)
| | | | - Pablo Cortegoso Valdivia
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy.
| | - Irene Stenfors
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Ivan Lyutakov
- Department of Gastroenterology, University Hospital “Tsaritsa Yoanna – ISUL”, Medical University Sofia, Bulgaria
| | | | - Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, Turin, Italy
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland,The Centre for Digestive Diseases, Endoklinika, Szczecin, Poland
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Odense Denmark
| | - Anastasios Koulaouzidis
- Department of Social Medicine & Public Health, Pomeranian Medical University, Szczecin, Poland
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
| |
Collapse
|
18
|
Benech N, Vinet O, Gaudin JL, Benamouzig R, Dray X, Ponchon T, Galmiche JP, Sacher-Huvelin S, Samaha E, Saurin JC. Colon capsule endoscopy in clinical practice: lessons from a national 5-year observational prospective cohort. Endosc Int Open 2021; 9:E1542-E1548. [PMID: 34540548 PMCID: PMC8445686 DOI: 10.1055/a-1526-0923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/25/2021] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Colon capsule endoscopy (CCE) has been proposed as an alternative to colonoscopy for screening patients at average risk of colorectal cancer (CRC). A prospective national cohort was developed to assess relevance of CCE in real-life practice and its short- and long-term impacts on clinical management. Patients and methods All patients who underwent a CCE in France were prospectively enrolled from January 2011 to May 2016 and reached annually by phone until May 2017. All CCE and colonoscopy reports were systematically collected. Results During the study period, 689 CCEs were analyzed from 14 medical centers. Median follow-up time was 35 months [IQR: 12-50]. Indication for CCE was mainly for elderly patients (median age: 70 years, IQR: [61-79]) due to anesthetic or colonoscopy contraindication (n = 307; 44.6 %). Only 337 CCEs (48.9 %) were both complete and with adequate bowel preparation. Advanced neoplasia (adenoma with high-grade dysplasia or CRC) was diagnosed following 32 CCEs (4.6 %). Among patients who underwent colonoscopy or therapeutic surgery following CCE, 18.8 % of all advanced neoplasias (6/32) had not been diagnosed by CCE mainly due to technical issues. Performing a colonoscopy in the case of significant polyps or insufficient bowel cleansing or after an incomplete CCE allowed the diagnosis of 96.9 % of all identified advanced neoplasias (31/32). Conclusions Outside the scope of academic trials, improvement is needed to increase the reliability of CCE as less than half were considered optimal i. e. complete with adequate bowel cleansing. Most of missed colonic advanced neoplasia were due to incomplete CCE with distal neoplasia location.
Collapse
Affiliation(s)
- Nicolas Benech
- Service d’Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Olivier Vinet
- Service d’Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jean-Louis Gaudin
- Service d’Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Robert Benamouzig
- Service de Gastro-entérologie, Hôpital d’Avicenne, Assistance Publique- Hôpitaux de Paris, Bobigny, France
| | - Xavier Dray
- Centre d’Endoscopie digestive, Hôpital Saint-Antoine, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Thierry Ponchon
- Service d’Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | | | - Elia Samaha
- Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Jean-Christophe Saurin
- Service d’Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | |
Collapse
|
19
|
Vuik FER, Nieuwenburg SAV, Moen S, Spada C, Senore C, Hassan C, Pennazio M, Rondonotti E, Pecere S, Kuipers EJ, Spaander MCW. Colon capsule endoscopy in colorectal cancer screening: a systematic review. Endoscopy 2021; 53:815-824. [PMID: 33440442 DOI: 10.1055/a-1308-1297] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Primary colonoscopy and fecal immunochemical test (FIT) are the most commonly used colorectal cancer (CRC) screening modalities. Colon capsule endoscopy (CCE) might be an alternative. Data on the performance of CCE as a CRC screening tool in a screening population remain scarce. This is the first systematic review to provide an overview of the applicability of CCE as a CRC screening tool. METHODS A systematic search was conducted of literature published up to September 2020. Studies reporting on CRC screening by second-generation CCE in an average-risk screening population were included. RESULTS 582 studies were identified and 13 were included, comprising 2485 patients. Eight studies used CCE as a filter test after a positive FIT result and five studies used CCE for primary screening. The polyp detection rate of CCE was 24 % - 74 %. For polyps > 6 mm, sensitivity of CCE was 79 % - 96 % and specificity was 66 % - 97 %. For polyps ≥ 10 mm, sensitivity of CCE was 84 % - 97 %, which was superior to computed tomographic colonography (CTC). The CRC detection rate for completed CCEs was 93 % (25/27). Bowel preparation was adequate in 70 % - 92 % of examinations, and completion rates varied from 57 % to 92 %, depending on the booster used. No CCE-related complications were described. CONCLUSION CCE appeared to be a safe and effective tool for the detection of CRC and polyps in a screening setting. Accuracy was comparable to colonoscopy and superior to CTC, making CCE a good alternative to colonoscopy in CRC screening programs, although completion rates require improvement.
Collapse
Affiliation(s)
- Fanny E R Vuik
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Stella A V Nieuwenburg
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sarah Moen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Cristiano Spada
- Digestive Endoscopy and Gastroenterology Unit, Poliambulanza Foundation, Brescia, Italy.,Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Catholic University, Rome, Italy
| | - Carlo Senore
- Epidemiology and Screening Unit - CPO, University Hospital Città della Salute e della Scienza, Turin Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Marco Pennazio
- University Gastroenterology Unit, Città della Salute e della Scienza University Hospital, Turin, Italy
| | | | - Silvia Pecere
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A, Gemelli IRCCS, Roma, Italia
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
20
|
Kjølhede T, Ølholm AM, Kaalby L, Kidholm K, Qvist N, Baatrup G. Diagnostic accuracy of capsule endoscopy compared with colonoscopy for polyp detection: systematic review and meta-analyses. Endoscopy 2021; 53:713-721. [PMID: 32858753 DOI: 10.1055/a-1249-3938] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Colon capsule endoscopy (CCE) is a technology that might contribute to colorectal cancer (CRC) screening programs as a filter test between fecal immunochemical testing and standard colonoscopy. The aim was to systematically review the literature for studies investigating the diagnostic yield of second-generation CCE compared with standard colonoscopy. METHODS A systematic literature search was performed in PubMed, Embase, and Web of Science. Study characteristics including quality of bowel preparation and completeness of CCE transits were extracted. Per-patient sensitivity and specificity were extracted for polyps (any size, ≥ 10 mm, ≥ 6 mm) and lesion characteristics. Meta-analyses of diagnostic yield were performed. RESULTS The literature search revealed 1077 unique papers and 12 studies were included. Studies involved a total of 2199 patients, of whom 1898 were included in analyses. The rate of patients with adequate bowel preparation varied from 40 % to 100 %. The rates of complete CCE transit varied from 57 % to 100 %. Our meta-analyses demonstrated that mean (95 % confidence interval) sensitivity, specificity, and diagnostic odds ratio were: 0.85 (0.73-0.92), 0.85 (0.70-0.93), and 30.5 (16.2-57.2), respectively, for polyps of any size; 0.87 (0.82-0.90), 0.95 (0.92-0.97), and 136.0 (70.6-262.1), respectively, for polyps ≥ 10 mm; and 0.87 (0.83-0.90), 0.88 (0.75-0.95), and 51.1 (19.8-131.8), respectively, for polyps ≥ 6 mm. No serious adverse events were reported for CCE. CONCLUSION CCE had high sensitivity and specificity for per-patient polyps compared with standard colonoscopy However, the relatively high rate of incomplete investigations limits the application of CCE in a CRC screening setting.
Collapse
Affiliation(s)
- Tue Kjølhede
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Anne Mette Ølholm
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Lasse Kaalby
- Department of Surgery, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristian Kidholm
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Niels Qvist
- Department of Surgery, Odense University Hospital, Odense, Denmark
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
21
|
Hosoe N, Limpias Kamiya KJL, Hayashi Y, Sujino T, Ogata H, Kanai T. Current status of colon capsule endoscopy. Dig Endosc 2021; 33:529-537. [PMID: 32542702 DOI: 10.1111/den.13769] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/16/2022]
Abstract
While both the annual incidence and mortality of colorectal cancer are slowly but steadily decreasing in the United States, the incidence of such malignancy is increasing in Japan. Thus, controlling colorectal cancer in Japan is a major concern. In 2006, colon capsule endoscopy was first introduced by Eliakim et al. First-generation colon capsule endoscopy had a moderate sensitivity for detecting polyps of more than 6 mm. Thus, second-generation colon capsule endoscopy was developed to achieve higher sensitivity. Colonoscopy is the gold standard tool for colorectal cancer surveillance. With an improvement in the imaging function, the performance of second-generation colon capsule endoscopy is almost as satisfactory as that of colonoscopy. Certain situations, such as incomplete colonoscopy and contraindication for use of sedation, can benefit from colon capsule endoscopy. Colon capsule endoscopy requires a more extensive bowel preparation than colonoscopy and computed tomography colonography because it requires laxatives not only for bowel cleansing but also for promoting the excretion of the capsule. Another problem with colon capsule endoscopy includes the burden of reading and interpretation and overlook of the lesions. Currently, the development of automatic diagnosis of colon capsule endoscopy using artificial intelligence is still under progress. Although the available guidelines do not support the use of colon capsule endoscopy for inflammatory bowel disease, the possible application of colon capsule endoscopy is ulcerative colitis. This review article summarizes and focuses on the current status of colon capsule endoscopy for colorectal cancer screening and the possibility for its applicability on inflammatory bowel disease.
Collapse
Affiliation(s)
- Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Kenji J L Limpias Kamiya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yukie Hayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomohisa Sujino
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
22
|
Möllers T, Schwab M, Gildein L, Hoffmeister M, Albert J, Brenner H, Jäger S. Second-generation colon capsule endoscopy for detection of colorectal polyps: Systematic review and meta-analysis of clinical trials. Endosc Int Open 2021; 9:E562-E571. [PMID: 33860073 PMCID: PMC8041571 DOI: 10.1055/a-1353-4849] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Adherence to colorectal cancer (CRC) screening is still unsatisfactory in many countries, thereby limiting prevention of CRC. Colon capsule endoscopy (CCE), a minimally invasive procedure, could be an alternative to fecal immunochemical tests or optical colonoscopy for CRC screening, and might increase adherence in CRC screening. This systematic review and meta-analysis evaluates the diagnostic accuracy of CCE compared to optical colonoscopy (OC) as the gold standard, adequacy of bowel preparation regimes and the patient perspective on diagnostic measures. Methods We conducted a systematic literature search in PubMed, EMBASE and the Cochrane Register for Clinical Trials. Pooled estimates for sensitivity, specificity and the diagnostic odds ratio with their respective 95 % confidence intervals (CI) were calculated for studies providing sufficient data. Results Of 840 initially identified studies, 13 were included in the systematic review and up to 9 in the meta-analysis. The pooled sensitivities and specificities for polyps ≥ 6 mm were 87 % (95 % CI: 83 %-90 %) and 87 % (95 % CI: 76 %-93 %) in 8 studies, respectively. For polyps ≥ 10 mm, the pooled estimates for sensitivities and specificities were 87 % (95 % CI: 83 %-90 %) and 95 % (95 % CI: 92 %-97 %) in 9 studies, respectively. A patients' perspective was assessed in 31 % (n = 4) of studies, and no preference of CCE over OC was reported. Bowel preparation was adequate in 61 % to 92 % of CCE exams. Conclusions CCE provides high diagnostic accuracy in an adequately cleaned large bowel. Conclusive findings on patient perspectives require further studies to increase acceptance/adherence of CCE for CRC screening.
Collapse
Affiliation(s)
- Tobias Möllers
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre, Heidelberg, Germany
| | - Matthias Schwab
- Dr. Margarete Fischer Bosch Institute of Clinical Pharmacology, Clinical Pharmacogenomics and Cancer, Stuttgart, Germany,Department of Clinical Pharmacology, University Hospitals Tubingen, Tubingen, Germany,Department of Pharmacy and Biochemistry, University of Tübingen, Tübingen, Germany,German Cancer Consortium, Partner Site Tubingen, Tubingen, Germany
| | - Lisa Gildein
- Department of Gastroenterology and Hepatology, Robert Bosch Hospital, Stuttgart, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre, Heidelberg, Germany
| | - Jörg Albert
- Department of Gastroenterology and Hepatology, Robert Bosch Hospital, Stuttgart, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre, Heidelberg, Germany,Division of Preventive Oncology, National Center for Tumor Diseases, Heidelberg, Germany,German Cancer Consortium, Heidelberg, Germany
| | - Simon Jäger
- Dr. Margarete Fischer Bosch Institute of Clinical Pharmacology, Clinical Pharmacogenomics and Cancer, Stuttgart, Germany,Department of Clinical Pharmacology, University Hospitals Tubingen, Tubingen, Germany
| |
Collapse
|
23
|
Shimozaki K, Hirata K, Horie S, Chida A, Tsugaru K, Hayashi Y, Kawasaki K, Miyanaga R, Hayashi H, Mizuno R, Funakoshi T, Hosoe N, Hamamoto Y, Kanai T. The Entire Intestinal Tract Surveillance Using Capsule Endoscopy after Immune Checkpoint Inhibitor Administration: A Prospective Observational Study. Diagnostics (Basel) 2021; 11:diagnostics11030543. [PMID: 33803735 PMCID: PMC8003297 DOI: 10.3390/diagnostics11030543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite the proven efficacy of immune checkpoint inhibitors (ICIs) against various types of malignancies, they have been found to induce immune-related adverse events, such as enterocolitis; however, the clinical features of ICI-induced enterocolitis remain to be sufficiently elucidated, which is significant, considering the importance of early detection in the appropriate management and treatment of ICI-induced enterocolitis. Therefore, the current study aimed to determine the utility of capsule endoscopy as a screening tool for ICI-induced enterocolitis. METHODS This single-center, prospective, observational study was conducted on patients with malignancy who received any ICI between April 2016 and July 2020 at Keio University Hospital. Next, second-generation capsule endoscopy (CCE-2) was performed on day 60 after ICI initiation to explore the entire gastrointestinal tract. RESULTS Among the 30 patients enrolled herein, 23 underwent CCE-2. Accordingly, a total of 23 findings were observed in 14 (60.8%) patients at any portion of the gastrointestinal tract (7 patients in the colon, 4 patients in the small intestine, 2 patients in both the colon and the small intestine, and 1 patient in the stomach). After capsule endoscopy, 2 patients (8.7%) developed ICI-induced enterocolitis: both had significantly higher Capsule Scoring of Ulcerative Colitis than those who had not developed ICI-induced enterocolitis (p = 0.0455). No adverse events related to CCE-2 were observed. CONCLUSIONS CCE-2 might be a safe and useful entire intestinal tract screening method for the early detection of ICI-induced enterocolitis in patients with malignancies.
Collapse
Affiliation(s)
- Keitaro Shimozaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Kenro Hirata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
- Correspondence: ; Tel.: +81-3-3353-1211
| | - Sara Horie
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Akihiko Chida
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Kai Tsugaru
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Yukie Hayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Kenta Kawasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Ryoichi Miyanaga
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Hideyuki Hayashi
- Keio Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan; (H.H.); (Y.H.)
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo 160-8582, Japan;
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo 160-8582, Japan;
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan;
| | - Yasuo Hamamoto
- Keio Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan; (H.H.); (Y.H.)
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| |
Collapse
|
24
|
Jiang XL, Wang JS, He JH. Summary of The Third Capsule Endoscopy Global Summit. Shijie Huaren Xiaohua Zazhi 2021; 29:210-216. [DOI: 10.11569/wcjd.v29.i4.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In order to emphasize the epidemic prevention during capsule endoscopy examinations, exhibit the latest achievements of capsule endoscopy, and strengthen international exchanges and cooperation in capsule endoscopy products, quality control, R&D, clinical applications, and talents, The Third Capsule Endoscopy Global Summit was held in Chongqing, China. The summit invited foreign experts to live online and remotely broadcast special academic speeches. The invited domestic experts brought the latest academic reports on the spot. A total of 17 medical experts presented a number of latest technologies and academic achievements in the field of capsule endoscopy from five levels. Professor Xue-Liang Jiang, President of the World Chinese Digestive Society and Editor-in-Chief of the World Chinese Journal of Digestology, was invited to give a report on the clinical application of capsule endoscopy.
Collapse
Affiliation(s)
- Xue-Liang Jiang
- Digestive Center of the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250001, Shandong Province, China
| | - Jin-Shan Wang
- Jinshan Science & Technology Limited Company, Chongqing 404100, China
| | - Jian-Hua He
- Jinshan Science & Technology Limited Company, Chongqing 404100, China
| |
Collapse
|
25
|
Abstract
PURPOSE OF REVIEW In the United States, only 67% of patients are up to date with colorectal cancer (CRC) screening. While colonoscopy is highly sensitive and specific for CRC and precursor lesion detection and removal, it is invasive, expensive and resource heavy. Hence, there is an unfulfilled need for multiple modality CRC screening that can improve current CRC screening rates and may be resource effective strategies when used in conjunction with a colonoscopy program. Our review highlights the complementary, often underutilized, noninvasive CRC screening methods with a focus on performance, risks, benefits, and recent updates. RECENT FINDINGS Studies demonstrate that fecal immunochemical testing (FIT) is superior to guaiac-based fecal occult blood tests for CRC screening. Studies show superiority of multitarget stool DNA test to FIT in sensitivity, though with concern for decreased specificity in setting of one-time tests. Technical advances continue to improve accuracy of colon capsule endoscopy. There are ongoing studies to characterize often difficult-to-detect high-risk lesions in computed tomography colonography. Septin 9 continues to have suboptimal accuracy for CRC screening, but has been shown to be associated with more advanced, invasive CRC stages. SUMMARY There are ongoing advances in noninvasive screening modalities for CRC; these should be considered as alternatives to colonoscopy in specific patient populations.
Collapse
Affiliation(s)
- Susan Lou
- Division of Gastroenterology, Department of Medicine, University of Minnesota
| | - Aasma Shaukat
- Division of Gastroenterology, Department of Medicine, University of Minnesota
- Division of Gastroenterology, Department of Medicine, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| |
Collapse
|
26
|
Houwen BB, Dekker E. Colon Capsule Endoscopy: An Alternative for Conventional Colonoscopy? Clin Endosc 2021; 54:4-6. [PMID: 33472344 PMCID: PMC7939767 DOI: 10.5946/ce.2021.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/16/2021] [Accepted: 01/16/2021] [Indexed: 12/26/2022] Open
Affiliation(s)
- Britt B.S.L. Houwen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
27
|
Spada C, Hassan C, Bellini D, Burling D, Cappello G, Carretero C, Dekker E, Eliakim R, de Haan M, Kaminski MF, Koulaouzidis A, Laghi A, Lefere P, Mang T, Milluzzo SM, Morrin M, McNamara D, Neri E, Pecere S, Pioche M, Plumb A, Rondonotti E, Spaander MC, Taylor S, Fernandez-Urien I, van Hooft JE, Stoker J, Regge D. Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline - Update 2020. Endoscopy 2020; 52:1127-1141. [PMID: 33105507 DOI: 10.1055/a-1258-4819] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
1: ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia.Strong recommendation, high quality evidence.ESGE/ESGAR do not recommend barium enema in this setting.Strong recommendation, high quality evidence. 2: ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. The timing depends on an interdisciplinary decision including endoscopic and radiological factors.Strong recommendation, low quality evidence.ESGE/ESGAR suggests that, in centers with expertise in and availability of colon capsule endoscopy (CCE), CCE preferably the same or the next day may be considered if colonoscopy is incomplete.Weak recommendation, low quality evidence. 3: When colonoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with alarm symptoms.Strong recommendation, high quality evidence.Because of lack of direct evidence, ESGE/ESGAR do not recommend CCE in this situation.Very low quality evidence.ESGE/ESGAR recommend CTC as an acceptable alternative to colonoscopy for patients with non-alarm symptoms.Strong recommendation, high quality evidence.In centers with availability, ESGE/ESGAR suggests that CCE may be considered in patients with non-alarm symptoms.Weak recommendation, low quality evidence. 4: Where there is no organized fecal immunochemical test (FIT)-based population colorectal screening program, ESGE/ESGAR recommend CTC as an option for colorectal cancer screening, providing the screenee is adequately informed about test characteristics, benefits, and risks, and depending on local service- and patient-related factors.Strong recommendation, high quality evidence.ESGE/ESGAR do not suggest CCE as a first-line screening test for colorectal cancer.Weak recommendation, low quality evidence. 5: ESGE/ESGAR recommend CTC in the case of a positive fecal occult blood test (FOBT) or FIT with incomplete or unfeasible colonoscopy, within organized population screening programs.Strong recommendation, moderate quality evidence.ESGE/ESGAR also suggest the use of CCE in this setting based on availability.Weak recommendation, moderate quality evidence. 6: ESGE/ESGAR suggest CTC with intravenous contrast medium injection for surveillance after curative-intent resection of colorectal cancer only in patients in whom colonoscopy is contraindicated or unfeasibleWeak recommendation, low quality evidence.There is insufficient evidence to recommend CCE in this setting.Very low quality evidence. 7: ESGE/ESGAR suggest CTC in patients with high risk polyps undergoing surveillance after polypectomy only when colonoscopy is unfeasible.Weak recommendation, low quality evidence.There is insufficient evidence to recommend CCE in post-polypectomy surveillance.Very low quality evidence. 8: ESGE/ESGAR recommend against CTC in patients with acute colonic inflammation and in those who have recently undergone colorectal surgery, pending a multidisciplinary evaluation.Strong recommendation, low quality evidence. 9: ESGE/ESGAR recommend referral for endoscopic polypectomy in patients with at least one polyp ≥ 6 mm detected at CTC or CCE.Follow-up CTC may be clinically considered for 6 - 9-mm CTC-detected lesions if patients do not undergo polypectomy because of patient choice, comorbidity, and/or low risk profile for advanced neoplasia.Strong recommendation, moderate quality evidence.
Collapse
Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy.,Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Davide Bellini
- Department of Radiological Sciences, Oncology and Pathology, La Sapienza University of Rome, Diagnostic Imaging Unit, I.C.O.T. Hospital Latina, Italy
| | | | - Giovanni Cappello
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Cristina Carretero
- Department of Gastroenterology. University of Navarre Clinic, Healthcare Research Institute of Navarre, Pamplona, Spain
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location AMC, The Netherlands
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center , Sackler School of Medicine, Tel-Aviv, Israel
| | - Margriet de Haan
- Department of Radiology, University Medical Center, Utrecht, The Netherlands
| | - Michal F Kaminski
- Departments of Gastroenterological Oncology and Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anastasios Koulaouzidis
- Endoscopy Unit, Centre for Liver and Digestive Disorders, University Hospitals, NHS Lothian, Edinburgh, UK
| | - Andrea Laghi
- Department of Surgical-Medical Sciences and Translational Medicine, La Sapienza University of Rome, Italy
| | - Philippe Lefere
- Department of Radiology, Stedelijk Ziekenhuis, Roeselare, Belgium
| | - Thomas Mang
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sebastian Manuel Milluzzo
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy.,Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Morrin
- RCSI Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Deirdre McNamara
- TAGG Research Centre, Department of Clinical Medicine, Trinity Centre, Tallaght Hospital, Dublin, Ireland
| | - Emanuele Neri
- Diagnostic Radiology 3, Department of Translational Research, University of Pisa, Italy
| | - Silvia Pecere
- Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Andrew Plumb
- Centre for Medical Imaging, University College London, London, UK
| | | | - Manon Cw Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Stuart Taylor
- Centre for Medical Imaging, University College London, London, UK
| | | | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
| | - Jaap Stoker
- Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Daniele Regge
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy.,University of Turin Medical School, Turin, Italy
| |
Collapse
|
28
|
Nunoo-Mensah JW, Giordano P, Chung-Faye G. COVID-19: An Opportunity to Reimagine Colorectal Cancer Diagnostic Testing-A New Paradigm Shift. Clin Colorectal Cancer 2020; 19:227-230. [PMID: 32921580 PMCID: PMC7395219 DOI: 10.1016/j.clcc.2020.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Joseph W Nunoo-Mensah
- Department of Colorectal Surgery, King's College Hospital Foundation NHS Trust, London, UK; Cleveland Clinic London, London, UK.
| | - Pasquale Giordano
- Department of Colorectal Surgery, Whipps Cross University Hospital, London, UK
| | - Guy Chung-Faye
- Department of Gastroenterology, King's College Hospital Foundation NHS Trust, London, UK
| |
Collapse
|
29
|
Spada C, Hassan C, Bellini D, Burling D, Cappello G, Carretero C, Dekker E, Eliakim R, de Haan M, Kaminski MF, Koulaouzidis A, Laghi A, Lefere P, Mang T, Milluzzo SM, Morrin M, McNamara D, Neri E, Pecere S, Pioche M, Plumb A, Rondonotti E, Spaander MC, Taylor S, Fernandez-Urien I, van Hooft JE, Stoker J, Regge D. Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline – Update 2020. Eur Radiol 2020; 31:2967-2982. [PMID: 33104846 DOI: 10.1007/s00330-020-07413-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit and Gastronenterology, Fondazione Poliambulanza, Brescia, Italy.
- Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Davide Bellini
- Department of Radiological Sciences, Oncology and Pathology, Diagnostic Imaging Unit, La Sapienza University of Rome, I.C.O.T. Hospital, Latina, Italy
| | | | - Giovanni Cappello
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Cristina Carretero
- Department of Gastroenterology, University of Navarre Clinic, Healthcare Research Institute of Navarre, Pamplona, Spain
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location AMC, Amsterdam, The Netherlands
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Margriet de Haan
- Department of Radiology, University Medical Center, Utrecht, The Netherlands
| | - Michal F Kaminski
- Departments of Gastroenterological Oncology and Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anastasios Koulaouzidis
- Endoscopy Unit, Centre for Liver and Digestive Disorders, University Hospitals, NHS Lothian, Edinburgh, UK
| | - Andrea Laghi
- Department of Surgical-Medical Sciences and Translational Medicine, La Sapienza University of Rome, Rome, Italy
| | - Philippe Lefere
- Department of Radiology, Stedelijk Ziekenhuis, Roeselare, Belgium
| | - Thomas Mang
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sebastian Manuel Milluzzo
- Digestive Endoscopy Unit and Gastronenterology, Fondazione Poliambulanza, Brescia, Italy
- Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Morrin
- RCSI Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Deirdre McNamara
- TAGG Research Centre, Department of Clinical Medicine, Trinity Centre, Tallaght Hospital, Dublin, Ireland
| | - Emanuele Neri
- Diagnostic Radiology 3, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Silvia Pecere
- Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Andrew Plumb
- Centre for Medical Imaging, University College London, London, UK
| | | | - Manon Cw Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Stuart Taylor
- Centre for Medical Imaging, University College London, London, UK
| | | | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap Stoker
- Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Daniele Regge
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
- University of Turin Medical School, Turin, Italy
| |
Collapse
|
30
|
González-Suárez B, Pagés M, Araujo IK, Romero C, Rodríguez de Miguel C, Ayuso JR, Pozo À, Vila-Casadesús M, Serradesanferm A, Ginès À, Fernández-Esparrach G, Pellisé M, López-Cerón M, Flores D, Córdova H, Sendino O, Grau J, Llach J, Serra-Burriel M, Cárdenas A, Balaguer F, Castells A. Colon capsule endoscopy versus CT colonography in FIT-positive colorectal cancer screening subjects: a prospective randomised trial-the VICOCA study. BMC Med 2020; 18:255. [PMID: 32943059 PMCID: PMC7500543 DOI: 10.1186/s12916-020-01717-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/22/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Colon capsule endoscopy (CCE) and CT colonography (CTC) are minimally invasive techniques for colorectal cancer (CRC) screening. Our objective is to compare CCE and CTC for the identification of patients with colorectal neoplasia among participants in a CRC screening programme with positive faecal immunochemical test (FIT). Primary outcome was to compare the performance of CCE and CTC in detecting patients with neoplastic lesions. METHODS The VICOCA study is a prospective, single-centre, randomised trial conducted from March 2014 to May 2016; 662 individuals were invited and 349 were randomised to CCE or CTC before colonoscopy. Endoscopists were blinded to the results of CCE and CTC. RESULTS Three hundred forty-nine individuals were included: 173 in the CCE group and 176 in the CTC group. Two hundred ninety individuals agreed to participate: 147 in the CCE group and 143 in the CTC group. In the intention-to-screen analysis, sensitivity, specificity and positive and negative predictive values for the identification of individuals with colorectal neoplasia were 98.1%, 76.6%, 93.7% and 92.0% in the CCE group and 64.9%, 95.7%, 96.8% and 57.7% in the CTC group. In terms of detecting significant neoplastic lesions, the sensitivity of CCE and CTC was 96.1% and 79.3%, respectively. Detection rate for advanced colorectal neoplasm was higher in the CCE group than in the CTC group (100% and 93.1%, respectively; RR = 1.07; p = 0.08). Both CCE and CTC identified all patients with cancer. CCE detected more patients with any lesion than CTC (98.6% and 81.0%, respectively; RR = 1.22; p = 0.002). CONCLUSION Although both techniques seem to be similar in detecting patients with advanced colorectal neoplasms, CCE is more sensitive for the detection of any neoplastic lesion. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02081742 . Registered: September 16, 2013.
Collapse
Affiliation(s)
- Begoña González-Suárez
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
| | - Mario Pagés
- Radiology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Isis Karina Araujo
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Cristina Romero
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Juan Ramón Ayuso
- Radiology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Àngels Pozo
- Department of Preventive Medicine and Epidemiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Maria Vila-Casadesús
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Anna Serradesanferm
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Department of Preventive Medicine and Epidemiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Àngels Ginès
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Glòria Fernández-Esparrach
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Maria Pellisé
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - María López-Cerón
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - David Flores
- Radiology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Henry Córdova
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Oriol Sendino
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Jaume Grau
- Department of Preventive Medicine and Epidemiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Josep Llach
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Miquel Serra-Burriel
- Center for Research in Health and Economic, Pompeu Fabra University, Barcelona, Spain
| | - Andrés Cárdenas
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| |
Collapse
|