Does The Colonic Capsule Pillcam Colon (R) Efficiently Screen Patients Who Would Deserve A Complete Colonoscopy For Colo-Rectal Cancer Screening?

Colo-rectal cancer (CRC) screening is based on fecal occult blood test in large populations and more recently on a colonoscopy recommended at the age of 50. This attitude has led to perform a number of normal colonoscopies. Preliminary studies have shown the possibility to detect colonic polyps and tumors with the PillCam Colon capsule (CCE) (Given Imaging Yoqneam, Israel). The aim of the present study was to evaluate the positive (PPV) and negative (NPV) predictive value of the colonic capsule to detect colonic diseases and polyps as compared to colonoscopy and test the assumption that it could accurately discriminate patients deserving a complete colonoscopy in the frame of CRC screening. Patients and Method: 77 patients (43 men, 54 ± 14 years) with an indication of colonoscopy (Familial history 24, personal history 13, IBD 3, iron-deficiency anaemia 4, rectal bleeding 18, change in bowel habits 15) were investigated by CCE followed on the next day by colonoscopy under general anaesthesia, as usually performed at our Institution. Bowel cleansing was obtained according to the previously published protocol (Endoscopy 2006;38:971-7). All CCE recordings were read by the same physician (GG) and all colonoscopies performed by the same operator (MD), unaware of the results of the CCE before the end of the colonoscopy. The primary outcome of the study was the decision made by the CCE reader to indicate a colonoscopy, compared with the final result of the colonoscopy Secondary outcomes were the agreement between CCE and colonoscopy for making a diagnosis of colo-rectal disease, detection rate, number and size of the polyps. Results. 2 patients were excluded: 1 did not swallow the capsule and 1 was diagnosed with a jejunal stenosis by the CCE. The mean colonic transit time of the capsule was 157 ± 132 min. (ext. 5-481min.). CCE was normal in 17 (22%) and colonoscopy in 34 patients (31%). Polyps were detected in 36 patients by CCE (48.5%) and in 44 by colonoscopy (58.8%). CCE results indicated a colonoscopy in 48 patients (64.7%) and the colonoscopy results confirmed this indication in 44 (57.4%). The PPV of CCE was 75% and the NPV, 62%. The agreement between CCE and colonoscopy was significant for the detection of any colonic lesion (kappa = 0.68, P < 0.0001), detection of polyps (kappa = 0.47, P < 0.001), number (kappa = 0.32, P < 0.02) and size of the polyps (r = 0.84, P = 0.0007). Conclusion: The results of this preliminary study show the clinical usefulness of the CCE to detect colo-rectal diseases in patients referred for CRC screening. However, the PPV and NPV of the CCE for detection of the polyps need to be further improved to propose it in larger CRC screening programs.