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Colon Capsule Endoscopy for Colorectal Cancer Screening, Diagnosis, and Surveillance

November 25, 2019

Health Problem: Colorectal cancer (CRC) is the second leading cause of cancer death in men and the third in women. Although screening for CRC has been found to reduce CRC mortality, many patients do not undergo the recommended screening.

Technology Description: Colon capsule endoscopy (CCE) is a minimally invasive technique that uses a wireless, miniature camera to capture images of the interior lining of the colon and rectum as the capsule moves through the gastrointestinal tract. CCE is intended for use as an alternative to conventional colonoscopy (CC) for the diagnosis and surveillance of adults with signs and symptoms of disease and to detect CRC in asymptomatic adults.

Controversy: CCE has several disadvantages compared with CC since the operator does not have direct access to the colon and cannot control movement of the capsule camera, spray a wash solution to obtain better views of suspicious lesions, or perform biopsies during the examination. In addition, the capsule may become lodged in patients who have small bowel stenosis or a large bowel diverticulum. In addition, the role of CCE in CRC screening is uncertain due to the paucity of evidence on its use for this indication.

Key Questions:

  • What is the diagnostic accuracy of CCE for the detection of colorectal polyps or CRC?
  • How does the diagnostic accuracy of CCE compare with other methods of CRC screening, diagnosis, or surveillance?
  • Does CCE reduce the incidence of CRC and CRC mortality?
  • Is CCE associated with any safety issues?
  • Have patient selection criteria been established for CCE for CRC screening, diagnosis, or surveillance?