IRISH SOCIETY OF GASTROENTEROLOGY SUMMER MEETING 2020
ISG Winter Meeting 2019 Oral Prize - First Prize
Tallaght University Hospital, Dublin
Colon capsule endoscopy (CCE) is an effective filter test for colonic polyp surveillance.
S. Semenov*, T. Manoharan, S. Sihag*, K. Hazel*, D. Molloy*, B. Ryan, N. Breslin, A. O’Connor*, D. McNamara*.
Department of Gastroenterology, Tallaght University Hospital, Tallaght, Dublin 24 and Trinity Academic Gastroenterology Group, Trinity College Dublin*.
Surveillance accounts for 30% of colonoscopy workload, the majority are normal. Identifying patients who require polypectomy would be advantageous. Current risk stratification performs poorly.
Assess CCE and/or faecal immunochemical test (FIT) as a filter in surveillance.
Following ethical approval, patients due polyp surveillance only, aged 18–80 were identified from our waiting list, then invited for CCE and FIT, and grouped according to BSG risk stratification. Any polyps, CRC (colorectal cancer), IBD or bleeding were significant CCE findings. ESGE defined CCE significant lesions (>3 polyps, >6mm), incomplete studies, positive FITs (≥225ng/ml) required endoscopy.
Of 803 surveillance patients, 300 (37%) met the inclusion criteria, 250 were invited with a 47% (118/250) uptake rate. Of 84 analysed CCEs (mean age 66 (38-80), 48 (57%) males), 72 (86%) returned FITs. Completion rate was 71% (60/84). Image quality was inadequate in 5 (6%). Overall, CCE positivity was 69% (58/84) with 48% (28/58) having significant polyps. Of colonoscopies completed to date, the true positive CCE rate was 90% (18/20). BSG high risk surveillance patients were more likely to have a positive CCE (n=58, p<0.0001, OR 4.4, 95%CI -0.43 to -0.22) as were older patients ≥70 (OR 3.6, p=0.02, 95%CI 1.2135 to 11.0267). There were no CCE complications and extracolonic findings were reported in 2% (2/84). 2/72 (3%) FIT results were positive. (+)FIT and CCE concordance was 100%, but FIT sensitivity was inadequate (4%). In all, only 45/84 (54%) require endoscopy (31 (37%) colonoscopy, 14 (17%) sigmoidoscopy).
Unlike FIT, CCE is useful in selecting patients for polypectomy in polyp surveillance and avoiding unnecessary colonoscopy.