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Capsule endoscopy demonstrated low sensitivity in detecting polyps, adenomas
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An ingestible capsule containing an endoscope equipped with a video camera allowed visualization of the colonic mucosa, but the sensitivity of the technique for detecting colorectal polyps and cancer was low compared with colonoscopy, according to results from a European prospective, multicenter study.
Researchers compared the sensitivity and specificity of capsule endoscopy and optical colonoscopy in 328 patients with a mean age of 58.6 who had known or suspected colonic disease.
Eight patients were excluded from the analysis. In five of these patients, the capsule did not reach the colon before the battery died; two had incomplete colonoscopy; and one was unable to swallow the capsule. Most patients (92.8%) excreted the capsule within 10 hours after ingestion and before the battery died.
Sensitivity of capsule endoscopy for detecting polyps ≥6 mm was 64% (95% CI, 59-72) and specificity for detecting these polyps was 84% (95% CI, 81-87). Sensitivity of capsule endoscopy for detecting advanced adenoma was 73% (95% CI, 61-83) and specificity for detecting advanced adenoma was 79% (95% CI, 77-81).
Colonoscopy detected 19 cancers; among these, 14 were detected by capsule endoscopy as well (sensitivity, 74%; 95% CI, 52-88). Both colonoscopy and capsule endoscopy detected advanced adenomas <6 mm in four patients. Colonoscopy detected advanced adenomas of any size in 52 patients (16.2%) whereas capsule endoscopy detected advanced adenomas in 44 patients (13.8%).
Sensitivity of capsule endoscopy was higher for patients who had good or excellent colon cleanliness compared with those who had fair or poor colon cleanliness. Twenty-six patients (7.9%) experienced mild to moderate adverse events, most of which were related to the colon preparation.
In an accompanying editorial, Michael Bretthauer, MD, PhD, of Oslo University Hospital in Norway, said that the low sensitivity of the capsule endoscopy for large adenomas is particularly concerning, considering that the size of colorectal lesions predicts cancer development.
“With the capsule’s relatively low sensitivity for the detection of colorectal lesions, its requirement for more extensive bowel-cleansing regimens as compared with colonoscopy and CT colonography and its high cost, colon capsule endoscopy cannot be recommended at this time,” Bretthauer wrote.
Van Gossum A. N Engl J Med. 2009;361:264-270.