Introduction
Colon capsule endoscopy (CCE) may be recommended as a screening test for individuals under the age of 50 with low familial risk, diagnosed with irritable bowel syndrome (IBS) but lacking alarming symptoms and showing no fecal immunochemical test (FIT) positivity.
Aims & Methods
In the present study, our aim was to assess the efficacy, feasibility and acceptance of CCE in IBS patients with low risk of CRC, and our secondary aim was to assess polyp detection rates, transit times, cleanliness level and patient satisfaction. From April 2022 to April 2024, we conducted a prospective study at our institution involving 196 patients with IBS under the age of 50 (130 (66%) males, 66 (44%) females). We applied first in the literature, the recently developed colon capsule endoscopy technology of the Anx Robotics (USA) Navicam dual-camera CCE for this comprehensive assessment. The new first generation Navicam CCE measures 31mm in length and 11.6mm in diameter, weighing approximately 3 grams. The two cameras operate at adaptive frame rate of 0.5 to 16 pic/sec, with adaptive focus of 0-30 mm, providing an image resolution of 480x480 pixels. The minimum battery time is 12h, and this is a fully functional panenteric capsule. Colonoscopy under anaesthesia was offered to all patients, and after detailed information and signing the consent form, they chose CCE as the first examination method. We identified and addressed the incomplete cases, recorded capsule transit times, and calculated the polyp detection rates. If polyps were detected, patients underwent subsequent colonoscopy with Propofol sedation for polyp removal and histological analysis.
Results
Out of the total cases, 8.7% (n=17) were incomplete. The average colon and total transit time was 201.95 and 360.55 mins, respectively. Our study revealed a remarkable 14.8% (n=29) polyp detection rate (PDR) among the participants. PDR varied across age groups (18-30yo: 12.5%, 31-40yo: 14.04%, 41-50yo: 17.39%). Polyp sizes were categorized as <5mm (n=20), 5-7mm (n=6), and >7mm (n=3). The majority of polyps were located in the sigmoid colon (n=12), followed by the unspecified left colon (n=10) and the right colon (n=7). Subsequent colonoscopy due to positive CCE performed in all patients and detected an additional 6 small polyps (<3mm). In 4 cases, colonoscopy yielded negative results. However, upon conducting a back-to-back colonoscopy all of the previously undetected polyps were eventually found. Histology results revealed one high-grade dysplastic polyp. The average cleanliness level of the colon was assessed using the CCE Cleansing Score (CC-CLEAR). For the coecum, the right and left colon, the average scores were 5.5-7-8, respectively. Impressively, 95% of participants reported high tolerance, and 91% of respondents expressed a preference for CCCE as the next screening procedure too and colonoscopy only after a positive CCE result.
Conclusion
Navicam colon capsule endoscopy emerges as a useful and feasible screening tool, demonstrating unparalleled promise in detecting polyps among asymptomatic individuals. Its polyp detection rate, cost-effectiveness, patient-friendly nature, and agreement with colonoscopy findings position it as a potent complementary method for advancing colorectal screening in low CRC risk individuals.