Utility of colon capsule endoscopy in colorectal cancer and post-polypectomy surveillance

OBJECTIVES: Surveillance colonoscopy is recommended for follow up of colorectal cancer and polyps. It has, however, a low yield in this setting and presents a significant strain on endoscopy capacity. Colon capsule endoscopy (CCE) is an alternative diagnostic. We aimed to determine the utility of this test in surveillance patients. METHODS: A retrospective analysis of a prospectively collated service evaluation data was conducted looking at all surveillance CCE patients in NHS Highland. The primary outcomes were the need for follow up endoscopy and capacity saved. Secondary outcomes included the CCE completion rate, and patient specific factors that contribute to an unsuccessful CCE or the need for a follow up endoscopy. RESULTS: One hundred forty-six patients underwent surveillance CCE between May 2023 and January 2025. Ninety-three (63.7%) required follow up endoscopy. Capacity saved was up to 35.2% of the time slots that would have otherwise been used if all had undergone colonoscopy. Opiate use was associated with CCE failure. Polyp, as opposed to cancer, surveillance and a history of multiple polyps on previous endoscopy were associated with increased follow up rate. CONCLUSION: CCE resulted in endoscopy capacity savings in this surveillance cohort, but it should be used selectively in view of the high follow up investigation rate. The benefit may be improved with careful patient selection and the exclusion of patients on opiates, tricyclic antidepresants, or who have a history of polyposis.