Addition of castor oil as a booster in colon capsule regimens significantly improves completion rates and polyp detection

Background: CCE is a diagnostic tool lacking clinical data on false negative rates. We aimed to assess this rate and the reader/technical error breakdown. Methods: False negative CCEs were identified after comparing to a colonoscopy database. Missed pathology characteristics and study indications/quality were collated. Cases were re-read by experts and newly identified lesions/pathologies were verified by an expert panel and categorised as reader/technical errors. Results: Of 532 CCEs, 203 had an adequately reported comparative colonoscopy, 45 (22.2%) had missed polyps, and 26/45 (57.8%) reached the colonic section with missed pathology. Of the cases, 22 (84.6%) had adequate bowel preparation. Indications included 13 (50%) polyp surveillance, 12 (46%) GI symptoms, 1 (4%) polyp screening. CCE missed 18 (69.2%) diminutive polyps and 8 (30.8%) polyps ≥ 6 mm, 18/26 (69.2%) of these were adenomas. Excluding incomplete CCE correlates, colonoscopy total and significant polyp yield were 97/184 (52.7%) and 50/97 (51.5%), respectively. CCE total polyp and significant polyp false negative rate was 26.8% (26/97) and 16% (8/50), respectively. Following re-reading, reader and technical error was 20/26 (76.9%) and 6/26 (23.1%). Total and significant missed polyp rates were 20.6% (20/97) and 14% (7/50) for reader error, 6.2% (6/97) and 2% (1/50) for technical error. Conclusions: False negative CCE rate is not insubstantial and should be factored into clinical decision making.

BACKGROUND Surveillance colonoscopies are predominantly normal, identifying patients for potential polypectomy is advantageous. AIM To assess colon capsule endoscopy (CCE) and/or faecal immunochemical test (FIT) as filters in surveillance. METHODS Patients aged ≥ 18 due for polyp surveillance were invited for CCE and FIT. Identifying polyps or colorectal cancer resulted in a positive CCE. Significant lesions (≥ 3 polyps or ≥ 6 mm polyps), incomplete studies and positive FITs (≥ 225 ng/mL) were referred for endoscopy. CCE and endoscopy results, FIT accuracy and patient preference were assessed. RESULTS From a total of 126 CCEs [mean age 64 (31-80), 67 (53.2%) males), 70.6% (89/126) were excreted, 86.5% (109/126) had adequate image quality. CCE positivity was 70.6% (89/126), 42.9% (54/126) having significant polyps with 63.5% (80/126) referred for endoscopy (19 sigmoidoscopies, 61 colonoscopies). CCE reduced endoscopy need by 36.5% (46/126) and 51.6% (65/126) were spared a colonoscopy. CCE positive predictive value was 88.2% (45/51). Significant extracolonic findings were reported in 3.2% (4/126). Patients with positive CCEs were older > 65 [odds ratio (OR) = 2.5, 95% confidence interval (CI): 1.1517-5.5787, P = 0.0159], with personal history of polyps (OR = 2.3, 95%CI: 0.9734-5.4066, P = 0.045), with high/intermediate polyp surveillance risk (OR = 5.4, 95%CI: 1.1979-24.3824, P = 0.0156). Overall, 5/114 (4.4%) FITs were positive (range: 0-1394 ng/mL, mean: 54 ng/mL). Sensitivity (9.6%) and negative predictive values (20.3%) were inadequate. Receiver operating curve analysis gave a sensitivity and specificity of 26.9% and 91.7%, for FIT of 43 ng/mL. Patients preferred CCE 63.3% (76/120), with less impact on daily activities (21.7% vs 93.2%) and time off work (average days 0.9 vs 1.2, P = 0.0201). CONCLUSION CCE appears effective in low-risk polyp surveillance. FIT does not appear to be of benefit in surveillance.