Efficacy Profiles of Minimally Invasive Colorectal Screening Techniques

Internal view of the intestinal walls. Colonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a camera on a flexible tube. 3d render
This study compared the effectiveness of both CT colonography and colon capsule endoscopy in detecting neoplastic lesions vs colonoscopy among patients in a colorectal cancer screening program with positive fecal immunochemical tests.

Study data published in BMC Medicine describe the performance characteristics of colon capsule endoscopy (CCE) and computed tomography colonography (CTC) for the detection of neoplastic lesions. Although both techniques had similar ability to identify advanced colorectal neoplasms, CCE was more sensitive for the detection of any neoplastic lesion.

Compared with colonoscopy, which requires sedation and extensive bowel preparation, CCE and CTC are minimally invasive techniques for colorectal cancer (CRC) screening. Investigators sought to assess the screening performances of CCE and CTC compared with traditional colonoscopy. The VICOCA study is a prospective randomized clinical trial conducted at a tertiary referral hospital in Barcelona, Spain. Researchers deemed patients with positive fecal immunochemical test results from the CRC screening program of Barcelona eligible for inclusion. They excluded patients with CRC, colorectal gastrointestinal symptoms, inflammatory bowel disease, family history of CRC, or total/partial colectomy. Investigators randomly assigned participants 1:1 to receive either CCE or CTC.

Colonoscopy was performed 1 to 2 weeks after randomized procedures and used as the “gold standard” comparator for both CCE and CTC. The primary outcomes were lesion detection rates for CCE and CTC vs colonoscopy. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were also reported.

A total of 145 participants underwent CCE, and 141 underwent CTC. Demographic characteristics were comparable between groups: The mean age was 60.1 plus or minus 5.8 years in the CCE group and 60 plus or minus 5.9 years in the CTC group. The CTC group had a greater proportion of women vs the CCE group (54.6% vs 42.8%). Sensitivity, specificity, PPV, and NPV of CCE examination for the detection of any neoplastic lesion were 98.1%, 76.6%, 93.6%, and 92%, respectively. Two (1.4%) patients had lesions at colonoscopy that were not detected by CCE.

For CTC, sensitivity, specificity, NPV, and PPV for neoplastic lesion detection were 64.8%, 95.7%, 96.8%, and 57.6%, respectively. A total of 33 (23.4%) patients had lesions detected on colonoscopy that CTC did not identify. In terms of detecting significant lesions (≥6 mm in size at colonoscopy), CCE and CTC had sensitivities of 96.1% and 79.3%, respectively (P =.0003). The corresponding specificities were 88.2% and 96.3% (P =.03).

The detection rate for advanced colorectal neoplasm was higher in the CCE vs CTC group, although the difference was not statistically significant (100% vs 93.1%; P =.08). Both CCE and CTC identified all patients with CRC; CCE detected more patients with any lesion compared with CTC (98.6% vs 81%; P =.002).

These data support the ability of both CCE and CTC to detect colorectal lesions; however, CCE was superior to CTC in the detection of any neoplasm, particularly small, flat, sessile, and serrated lesions. Nonetheless, the small number of patients with serrated lesions may have affected the reliability of this estimate. Further study is necessary to better explore the effectiveness of both techniques compared with colonoscopy.


González-Suárez B, Pagés M, Araujo IK, et al. Colon capsule endoscopy versus CT colonography in FIT-positive colorectal cancer screening subjects: a prospective randomised trial-the VICOCA study. BMC Med. 2020;18(1):255.