Abstract
BackgroundColonoscopy (CSPY) for colorectal cancer screening has several limitations. Colon Capsule Endoscopy (PillCam Colon, CCE) was compared to CSPY under routine screening conditions.MethodsWe performed a prospective, single-center pilot study at a University Hospital. Data were obtained from November 2007 until May 2008. Patients underwent CCE on Day 1 and CSPY on Day 2. Outcomes were evaluated regarding sensitivity and specificity of polyp detection rate, with a significance level set at >5 mm.Results59 individuals were included in this study, the results were evaluable in 56 patients (males 34, females 22; median age 59). CCE was complete in 36 subjects. Polyp detection rate for significant polyps was 11% on CSPY and 27% on CCE.6/56 (11%) patients had polyps on CSPY not detected on CCE (miss rate).Overall sensitivity was 79% (95% confidence interval [CI], 61 to 90), specificity was 54% (95% CI, 35 to 70), positive predictive value (PPV) was 63% and negative predictive value (NPV) was 71%. Adjusted to significance of findings, sensitivity was 50% (95% CI, 19 to 81), specificity was 76% (95% CI, 63 to 86), PPV was 20% and NPV was 93%.ConclusionIn comparison to the gold standard, the sensitivity of CCE for detection of relevant polyps is low, however, the high NPV supports its role as a possible screening tool.Trial RegistrationNCT00991003.
Highlights
Colonoscopy (CSPY) for colorectal cancer screening has several limitations
In comparison to the gold standard, the sensitivity of Colon capsule endoscopy (CCE) for detection of relevant polyps is low, the high negative predictive value (NPV) supports its role as a possible screening tool
Current evidence points to the important role of screening colonoscopy with subsequent polypectomy (CSPY), reducing the risk of developing CRC by 7690%[4,5,6]
Summary
Colonoscopy (CSPY) for colorectal cancer screening has several limitations. Colon Capsule Endoscopy (PillCam Colon, CCE) was compared to CSPY under routine screening conditions. The incidence of colorectal cancer [(CRC), standardized to age and world population] is 20-45/100.000 for men und 15-30/100.000 for women[1]. It is increasing with age[2] and the cumulative lifetime risk both for men and for women arises to 6%[3]. The majority (90%) of CRC develop from benign adenomatous polyps. Current evidence points to the important role of screening colonoscopy with subsequent polypectomy (CSPY), reducing the risk of developing CRC by 7690%[4,5,6]. Early recognization and removal of carcinomatous lesions is crucial, as 5-year survival rates for DUKES stage A (UICC 0 to 1) are above 90%, whereas overall 5-year-survival rate is 62%[7]
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