COLON CAPSULE VERSUS CT COLONOGRAPHY FOR COLORECTAL CANCER SCREENING IN PATIENTS WITH POSITIVE FOBT WHO REFUSED COLONOSCOPY: A RANDOMIZED TRIAL

Aims:

Around 10% of patients with a positive guaiac fecal occult blood test (gFOBT) will never undergo the recommended colonoscopy. Colon capsule endoscopy (CCE) and CT colonography (CTC) are two alternatives to explore the colon for adenoma detection. Aim of this study was to compare the participation and the outcomes of CCE and CTC when proposed to patients with positive gFOBT who never underwent the recommended colonoscopy.

Methods:

An invitation letter proposing CTC or CCE was sent to the selected patients after randomization. Acceptance of the proposed (or alternative) procedure and procedure results were collected.

Results:

A total of 756 patients were targeted. Following the invitation letter, 5.0% of patients underwent the proposed CCE (19/378) and 7.4% the proposed CTC (28/378, p = 0.189). Following the letter, 9.8% of patients in the CCE group (37/378) underwent a diagnostic procedure (19 CCE, 1 CTC, 17 colonoscopy) versus 10.8% in the CTC group (41/378: 28 CTC, 13 colonoscopy, p = 0.552). There were more potentially neoplastic lesions diagnosed in the CCE group than in the CTC group (12/20, 60.0% versus 8/28, 28.5%, p = 0.040). Thus, 15/20 non-invasive procedures in the CCE group (19 CCE, 1 CTC; 75.0%) versus 10/28 in the CTC group (35.7%; p = 0.01) resulted in further colonoscopy recommendation but only 10/25 patients really underwent this proposed colonoscopy.

Conclusions:

Patients with positive gFOBT who do not perform the recommended colonoscopy are difficult to recruit to the screening program and just proposing an additional less invasive procedure such as CCE or CTC is not an effective strategy.

Trial Registration number: NCT 02558881