Abstract
Background and study aims Colon capsule endoscopy (CCE) has been proposed as an alternative to colonoscopy for
screening patients at average risk of colorectal cancer (CRC). A prospective national
cohort was developed to assess relevance of CCE in real-life practice and its short-
and long-term impacts on clinical management.
Patients and methods All patients who underwent a CCE in France were prospectively enrolled from January
2011 to May 2016 and reached annually by phone until May 2017. All CCE and colonoscopy
reports were systematically collected.
Results During the study period, 689 CCEs were analyzed from 14 medical centers. Median follow-up
time was 35 months [IQR: 12–50]. Indication for CCE was mainly for elderly patients
(median age: 70 years, IQR: [61–79]) due to anesthetic or colonoscopy contraindication
(n = 307; 44.6 %). Only 337 CCEs (48.9 %) were both complete and with adequate bowel
preparation. Advanced neoplasia (adenoma with high-grade dysplasia or CRC) was diagnosed
following 32 CCEs (4.6 %). Among patients who underwent colonoscopy or therapeutic
surgery following CCE, 18.8 % of all advanced neoplasias (6/32) had not been diagnosed
by CCE mainly due to technical issues. Performing a colonoscopy in the case of significant
polyps or insufficient bowel cleansing or after an incomplete CCE allowed the diagnosis
of 96.9 % of all identified advanced neoplasias (31/32).
Conclusions Outside the scope of academic trials, improvement is needed to increase the reliability
of CCE as less than half were considered optimal i. e. complete with adequate bowel
cleansing. Most of missed colonic advanced neoplasia were due to incomplete CCE with
distal neoplasia location.
