Multicenter study of colon capsule endoscopy in post-polypectomy surveillance

Background and study aims: During the COVID-19 pandemic the National Health Service introduced colon capsule endoscopy (CCE) as an alternative to colonoscopy in patients awaiting 3-year post-polypectomy surveillance. We determined the safety, diagnostic accuracy, and utility of CCE in this clinical setting. Patients and methods: Consenting patients awaiting 3-year post-polypectomy surveillance underwent CCE or colonoscopy. For those having CCE, risk-based guidance was developed directing to: 1) immediate colorectal endoscopic intervention; 2) deferred intervention; or 3) discharge. The safety, comparative and paired diagnostic accuracy, and colonoscopy capacity spared by CCE were determined. Results: There were 464 CCE and 78 colonoscopy patients recruited. CCE patients were younger (mean 62 years versus 68 years). CCE was safely tolerated in 99% of patients. More ≥ 10 mm and 6- to 9-mm polyps were detected in the CCE cohort than the colonoscopy comparator cohort. This was on an intention to investigate basis and in those who had complete and adequately prepared examinations. Two hundred and five CCE patients had an urgent colonoscopy or flexible sigmoidoscopy and their paired findings were matched. Per patient sensitivities for ≥ 10 mm and 6- to 9-mm polyps were 92% and 90%, respectively. Two-thirds of patients entered a modified management pathway after CCE with 25% being discharged and 27% having a procedure deferral for up to 3 years. CCE completion and bowel preparation adequacy rates were 78% and 73% respectively. No colorectal cancer was detected. Conclusions: CCE is a safe diagnostic of colorectal polyps. In surveillance, its "filter function" complements existing colorectal diagnostic services by providing capacity and choice.