Colon capsule endoscopy today: Brief overview of leading UK and Danish initiatives.

Abstract

Background and study aims: In recent years, several large national studies have been published reporting on outcomes of colon capsule endoscopy (CCE) in both symptomatic and screening settings, significantly contributing to the expanding body of real-world evidence on CCE. Therefore, we have compiled these studies to provide an overview of key developments, current challenges, and valuable insights they offer into the evolving role of CCE.

Patients and methods: We examined three multicenter studies reporting on outcomes of CCE including the NHS England study with 4,878 symptomatic patients; the ScotCap pilot with 316 symptomatic patients; the ScotCap registry with 1,087 predominantly symptomatic patients (95.9%); and the CareForColon 2015 study with 1,790 patients in a screening setting. For the ScotCap pilot study, only symptomatic patients were included.

Results: ScotCap pilot reported the highest rate of adequate bowel preparation (79.4%) without using prucalopride. CareForColon2015 achieved a significantly higher rate of complete tests (91.7%) compared with other studies. NHS England reported a notably lower rate of follow-up endoscopy (46.7%), indicating effective patient selection. ScotCap pilot reported one case of missed colorectal cancer. Sensitivity of CCE for detecting polyps ≥ 10 mm ranged from 93.8% to 97.0% on a per-patient basis and from 75.0% to 95.8% on a per-polyp basis in the NHS England and ScotCap trials.

Conclusions: These national CCE programs reveal the complexity of large-scale implementation, driven by variations in definitions and protocols. Harmonized quality metrics and shared definitions of success are essential. Efforts should focus on reducing downstream procedures and fostering cross-system learning.