Comparison of colon capsule endoscopy and flexible colonoscopy, experiences in two Hungarian gastroenterology centres

Background and Aims: Colon capsule endoscopy (CCE) is a non-invasive and painless method for direct visualization of the large bowel without intubation. Flexible colonoscopy is currently the standard procedure for colon evaluation and screening for colorectal cancer and polyps. This study compared CCE with flexible colonoscopy for the detection colorectal polyps,cancers and diverticulosis. Methods: We performed a bi-center study comparing CCE with flexible colonoscopy in a cohort of patients with known or suspected colonic diseases. Patient underwent a special colon preparation and colon cleanliness was evaluated by a four grade scale. We analyzed the diagnostic yield as well as the sensitivity and specificity of CCE for polyps with different sizes, and diverticulosis. Results: A total of 17 patients (mean age, 57.6 years) were included in the study. CCE and total flexible colonoscopy were performed in all patients within a 3 months period. The diagnostic yield of CCE for any colonic lesions was 76.4% with a 2.7 cleanliness grade in average. Colorectal polyps were detected in 10 patients. The sensitivity and specificity of CCE for detecting polyps that were 6mm in size or bigger were 80% and 100%, respectively. For detecting polyps smaller than 6mm,the sensitivity and specificity were 85.7% and 75%, respectively. Both 2 cancers detected by colonoscopy were also seen by CCE. Out of the 6 colon diverticulosis cases detected by colonoscopy 4 were presented also by CCE. The exact number of polyps per patients registered by flexible colonoscopy was correctly detected by CCE only in 40% of cases. Conclusions: The use of CCE allows visualization of the colonic mucosa in most patients with an acceptable sensitivity for detecting polyps of any size. The diagnostic accuracy of CCE is highly influenced by the colonic cleanliness result. Although the precise number and location of polyps is rearly detectable by CCE the new non-invasive CCE technique seems to be a promising screening method to select those individuals who are the candidates for flexible colonoscopy.