BACKROUND: Capsule colonoscopy might present an alternative to colonoscopy for colorectal neoplasia screening. AIM: To assess the accuracy of second-generation capsule colonoscopy (CCE2) for colorectal neoplasia detection compared with conventional colonoscopy (CC). METHODS: From 2011-2015, we performed a multicenter, prospective, cross-over study evaluating the use of CCE2 as a possible colorectal cancer (CRC) screening test based on the assessment of the method's characteristics (accuracy) and safety and patient acceptance of the routine. Enrolled participants fulfilled the CRC screening population criteria if they were asymptomatic, were older than 50, and had no personal or familial history of colorectal neoplasia. The primary outcome was accuracy for the detection of polyps ≥ 6 mm. Secondary outcomes were accuracy for all polyps, polyps ≥ 10 mm, adenomas ≥ 10 mm, and cancers, the quality of bowel cleansing, safety, and CCE2 acceptability by the screening population. RESULTS: A total of 236 individuals were examined; 11 patients (5%) were excluded. Therefore, 225 subjects (95%) were considered in the intention-to-screen (ITS) group. A total of 201 patients (89%) completed both examinations successfully (per protocol group). In the ITS group, polyps were diagnosed during CC in 114 subjects (51%); polyps ≥ 6 mm, polyps ≥ 10 mm, and adenomas ≥ 10 mm were diagnosed in 34 (15%), 16 (7%), and 11 (5%) patients, respectively. The sensitivity of CCE2 for polyps ≥ 6 mm, polyps ≥ 10 mm, and adenomas ≥ 10 mm was 79% (95% confidence interval (CI): 62-91%), 88% (95% CI: 62-98%), and 100% (95% CI: 72-100%), respectively. CONCLUSION: Second-generation capsule colonoscopy is a safe, noninvasive, and sensitive method for colorectal neoplasia detection although CC remains the preferred method for considerable proportion of subjects. CCE2 may therefore be accepted as the primary screening test for colorectal cancer screening.

2nd Department of Internal Medicine Gastroenterology University Hospital Hradec Kralove Charles University Faculty of Medicine in Hradec Kralove Hradec Kralove CZ 500 05 Czech Republic

Charles University Prague Institute of Physiology Czech Republic

Department of Hepatogastroenterology Institute for Clinical and Experimental Medicine Prague CZ 140 21 Czech Republic

Department of Medicine 1st Faculty of Medicine Charles University Military University Hospital Prague CZ 169 02 Czech Republic

GEP Clinic Prague CZ 130 00 Czech Republic

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno CZ 625 00 Czech Republic

University of Ostrava Medical Faculty Czech Republic

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Kamangar F., Dores G. M., Anderson W. F. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. Journal of Clinical Oncology. 2006;24(14):2137–2150. doi: 10.1200/JCO.2005.05.2308. PubMed DOI

Bond J. H. Fecal occult blood testing for colorectal cancer: can we afford not to do this? Gastroenterology Clinics of North America. 1997;26(1):57–70. doi: 10.1016/S0889-8553(05)70283-1. PubMed DOI

Zavoral M., Suchanek S., Majek O., et al. Colorectal cancer screening: 20 years of development and recent progress. World Journal of Gastroenterology. 2014;20(14):3825–3834. doi: 10.3748/wjg.v20.i14.3825. PubMed DOI PMC

European Colorectal Cancer Screening Guidelines Working Group. European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication. Endoscopy. 2012;45(1):51–59. doi: 10.1055/s-0032-1325997. PubMed DOI PMC

Iddan G., Meron G., Glukhovsky A., Swain P. Wireless capsule endoscopy. Nature. 2000;405(6785):p. 417. doi: 10.1038/35013140. PubMed DOI

Spada C., Riccioni M. E., Hassan C., Petruzziello L., Cesaro P., Costamagna G. PillCam colon capsule endoscopy: a prospective, randomized trial comparing two regimens of preparation. Journal of Clinical Gastroenterology. 2011;45(2):119–124. doi: 10.1097/MCG.0b013e3181dac04b. PubMed DOI

Spada C., Hassan C., Galmiche J., et al. Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2012;44(5):527–536. doi: 10.1055/s-0031-1291717. PubMed DOI

Mandel J. S., Bond J. H., Church T. R., et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. The New England Journal of Medicine. 1993;328(19):1365–1371. doi: 10.1056/NEJM199305133281901. PubMed DOI

van Rossum L. G., van Rijn A. F., Laheij R. J., et al. Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population. Gastroenterology. 2008;135(1):82–90. doi: 10.1053/j.gastro.2008.03.040. PubMed DOI

Atkin W. S., Edwards R., Kralj-Hans I., et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. The Lancet. 2010;375(9726):1624–1633. doi: 10.1016/S0140-6736(10)60551-X. PubMed DOI

Kaminski M. F., Regula J., Kraszewska E., et al. Quality indicators for colonoscopy and the risk of interval cancer. The New England Journal of Medicine. 2010;362(19):1795–1803. doi: 10.1056/NEJMoa0907667. PubMed DOI

van Gossum A., Munoz-Navas M., Fernandez-Urien I., et al. Capsule endoscopy versus colonoscopy for the detection of polyps and cancer. The New England Journal of Medicine. 2009;361(3):264–270. doi: 10.1056/NEJMoa0806347. PubMed DOI

Kobaek-Larsen M., Kroijer R., Dyrvig A. K., et al. Back-to-back colon capsule endoscopy and optical colonoscopy in colorectal cancer screening individuals. Colorectal Disease. 2018;20(6):479–485. doi: 10.1111/codi.13965. PubMed DOI

Holleran G., Leen R., O’Morain C., McNamara D. Colon capsule endoscopy as possible filter test for colonoscopy selection in a screening population with positive fecal immunology. Endoscopy. 2014;46(6):473–478. doi: 10.1055/s-0034-1365402. PubMed DOI

Rex D. K., Adler S. N., Aisenberg J., et al. Accuracy of capsule colonoscopy in detecting colorectal polyps in a screening population. Gastroenterology. 2015;148(5):948–957.e2. doi: 10.1053/j.gastro.2015.01.025. PubMed DOI

Suchanek S., Majek O., Vojtechova G., et al. Colorectal cancer prevention in the Czech Republic: time trends in performance indicators and current situation after 10 years of screening. European Journal of Cancer Prevention. 2014;23(1):18–26. doi: 10.1097/CEJ.0b013e328364f203. PubMed DOI

Groth S., Krause H., Behrendt R., et al. Capsule colonoscopy increases uptake of colorectal cancer screening. BMC Gastroenterology. 2012;12(1):p. 80. doi: 10.1186/1471-230X-12-80. PubMed DOI PMC

Ojidu H., Palmer H., Lewandowski J., et al. Patient tolerance and acceptance of different colonic imaging modalities: an observational cohort study. European Journal of Gastroenterology & Hepatology. 2018;30(5):520–525. doi: 10.1097/MEG.0000000000001090. PubMed DOI

Voska M., Grega T., Ngo O., et al. The comparison of the efficiency of colon capsule endoscopy and optical colonoscopy in patients with positive immunochemical fecal occult blood test: multicenter, prospective study. Endoscopy. 2019;51(4, article S130) doi: 10.1055/s-0039-1681553. DOI