Aim

The aim of this work was to evaluate the performance of colon capsule endoscopy (CCE) in a lower gastrointestinal diagnostic care pathway.

Method

This large multicentre prospective clinical evaluation recruited symptomatic patients (patients requiring investigation of symptoms suggestive of colorectal pathology) and surveillance patients (patients due to undergo surveillance colonoscopy). Patients aged 18 or over, were invited to participate and undergo CCE by a secondary care clinician if they met the referral criteria for a colonoscopy. The primary outcome was the test completion rate (visualisation of the whole colon and rectum). We also measured the need for further test requirement after CCE.

Results

733 patients were invited to take part in this evaluation with 509 patients undergoing CCE. 316 were symptomatic patients and 193 were surveillance patients. 228/316 (72%) symptomatic patients and 137/193 (71%) surveillance patients had a complete test. 118/316 (37%) of symptomatic patients required no further test following CCE, 103/316 (33%) and 81/316 (26%) required a colonoscopy and flexible sigmoidoscopy, respectively. 53/193(28%) of surveillance patients required no further test following CCE, 104/193 (54%) and 30/193 (16%) required a colonoscopy and flexible sigmoidoscopy, respectively. No patient in this evaluation was diagnosed with colorectal cancer. 2 patients experienced serious adverse events – one capsule retention with obstruction and one hospital admission with dehydration due to the bowel preparation.

Conclusion

CCE is a safe, well tolerated diagnostic test which can reduce the proportion of patients requiring colonoscopy, but the test completion rate needs to be improved to match that of lower gastrointestinal endoscopy.