Endoscopy 2018; 50(08): 761-769
DOI: 10.1055/s-0044-100721
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Colon capsule versus computed tomography colonography for colorectal cancer screening in patients with positive fecal occult blood test who refuse colonoscopy: a randomized trial

Mathieu Pioche
 1  Hepatogastroenterology department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
 2  Lyon 1 University Claude Bernard, Lyon, France
,
Christell Ganne
 3  Research and Medical Information Division, Hospices Civils de Lyon, Lyon, France
,
Rodica Gincul
 1  Hepatogastroenterology department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
 4  Hepatogastroenterology Department, Mermoz Hospital, Lyon, France
,
Antoine De Leusse
 4  Hepatogastroenterology Department, Mermoz Hospital, Lyon, France
,
Julien Marsot
 5  Radiology Department, Mermoz Hospital, Lyon, France
,
Julien Balique
 5  Radiology Department, Mermoz Hospital, Lyon, France
,
Alain Fond
 5  Radiology Department, Mermoz Hospital, Lyon, France
,
Michel Bretagnolle
 5  Radiology Department, Mermoz Hospital, Lyon, France
,
Luc Henry
 6  Radiology Department, Clinique du Val d’Ouest, Lyon, France
,
Yann Billaud
 6  Radiology Department, Clinique du Val d’Ouest, Lyon, France
,
Romain Malezieux
 7  Radiology Department, Clinique du Parc, Saint-Priest en Jarez, France
,
Marie-Georges Lapalus
 8  Hepatogastroenterology Department, Hôpital Privé de L’est Lyonnais, Saint-Priest, France
,
Christine Chambon-Augoyard
 1  Hepatogastroenterology department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
,
Emilie Del Tedesco
 9  Hepatogastroenterology Department, University Hospital Saint-Etienne, Saint-Priest en Jarez, France
,
Olivia Scalone
10  Hepatogastroenterology Department, Nord Ouest Hospital, Villefranche-sur-Saône, France
,
Jean-Charles Montoy
11  Radiology Department, Clinique du Renaison, Roanne, France
,
Benoit Russias
11  Radiology Department, Clinique du Renaison, Roanne, France
,
Antoine Detry
11  Radiology Department, Clinique du Renaison, Roanne, France
,
Frédéric Veniat
11  Radiology Department, Clinique du Renaison, Roanne, France
,
Jin Qiu
12  Hepatogastroenterology Department, Public hospital, Roanne, France
,
Pierre-Jean Valette
13  Radiology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
,
Annabel Taillandier
14  Departmental Screening Management Association Rhône ADEMAS 69, Lyon, France
,
Jean-Christophe Saurin
 1  Hepatogastroenterology department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
 2  Lyon 1 University Claude Bernard, Lyon, France
,
Josiane Tomczyk-Ferrero
15  Departmental Screening Management Association Loire Vivre 42, Saint-Etienne, France
,
Clémentine Gandilhon
 1  Hepatogastroenterology department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
14  Departmental Screening Management Association Rhône ADEMAS 69, Lyon, France
,
Léa Vecchiato
14  Departmental Screening Management Association Rhône ADEMAS 69, Lyon, France
,
Patricia Soler-Michel
14  Departmental Screening Management Association Rhône ADEMAS 69, Lyon, France
,
Thierry Ponchon
 1  Hepatogastroenterology department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
› Author Affiliations
TRIAL REGISTRATION: Randomized, controlled trial 2012-A01294–39 at clinicaltrialsregister.eu.
Further Information

Publication History

submitted 11 August 2017

accepted after revision 19 December 2017

Publication Date:
27 February 2018 (eFirst)

Abstract

Objective Some patients (10 % – 32 %) with a positive guaiac fecal occult blood test (gFOBT) do not undergo the recommended colonoscopy. The aim of this study was to compare video capsule endoscopy (VCE) and computed tomography colonography (CTC) in terms of participation rate and detection outcomes when offered to patients with a positive gFOBT who did not undergo the recommended colonoscopy.

Methods An invitation letter offering CTC or VCE was sent to selected patients after randomization. Acceptance of the proposed (or alternative) procedure and procedure results were recorded. Sample size was evaluated according to the hypothesis of a 13 % increase of participation with VCE.

Results A total of 756 patients were targeted. Following the invitation letter, 5.0 % (19/378) of patients underwent the proposed VCE and 7.4 % (28/378) underwent CTC, (P = 0.18). Following the letter, 9.8 % (37/378) of patients in the VCE group underwent a diagnostic procedure (19 VCE, 1 CTC, 17 colonoscopy) vs. 10.8 % in the CTC group (41/378: 28 CTC, 13 colonoscopy; P = 0.55). There were more potentially neoplastic lesions diagnosed in the VCE group than in the CTC group (12/20 [60.0 %] vs. 8/28 [28.6 %]; P = 0.04). Thus, 15/20 noninvasive procedures in the VCE group (19 VCE, 1 CTC; 75.0 %) vs. 10/28 in the CTC group (35.7 %; P = 0.01) resulted in a recommendation of further colonoscopy, but only 10/25 patients actually underwent this proposed colonoscopy.

Conclusion Patients with a positive gFOBT result who do not undergo the recommended colonoscopy are difficult to recruit to the screening program and simply proposing an additional, less-invasive procedure, such as VCE or CTC, is not an effective strategy.

ClinicalTrials.govNCT02558881TRIAL REGISTRATION: Randomized, controlled trial NCT02558881 at clinicaltrials.gov.