Patient-Reported Outcomes and Preferences for Colon Capsule Endoscopy and Colonoscopy: A Systematic Review with Meta-Analysis

Colon capsule endoscopy as an alternative to colonoscopy for the diagnosis of colonic disease may serve as a less invasive and more tolerable investigation for patients. Our aim was to examine patient-reported outcomes for colon capsule endoscopy compared to conventional optical colonoscopy including preference of investigation modality, tolerability and adverse events. A systematic literature search was conducted in Web of Science, PubMed and Embase. Search results were thoroughly screened for in- and exclusion criteria. Included studies underwent assessment of transparency and completeness, after which, data for meta-analysis were extracted. Pooled estimates of patient preference were calculated and heterogeneity was examined including univariate meta-regressions. Patient-reported tolerability and adverse events were reviewed. Out of fourteen included studies, twelve had investigated patient-reported outcomes in patients who had undergone both investigations, whereas in two the patients were randomized between investigations. Pooled patient preferences were estimated to be 52% (CI 95%: 41–63%) for colon capsule endoscopy and 45% (CI 95%: 33–57%) for conventional colonoscopy: not indicating a significant difference. Procedural adverse events were rarely reported by patients for either investigation. The tolerability was high for both colon capsule endoscopy and conventional colonoscopy. Patient preferences for conventional colonoscopy and colon capsule endoscopy were not significantly different. Procedural adverse events were rare and the tolerability for colon capsule endoscopy was consistently reported higher or equal to that of conventional colonoscopy.

Download Full-text

Comparison of small-bowel colon capsule endoscopy system to conventional colonoscopy for the evaluation of ulcerative colitis activity

Endoscopy International Open ◽

10.1055/a-0982-2786 ◽

2019 ◽

Vol 07 (10) ◽

pp. E1253-E1261 ◽

Cited By ~ 1

Author(s):

Samuel N. Adler ◽

Yago González Lama ◽

Virginia Matallana Royo ◽

Cristina Suárez Ferrer ◽

Avraham Schwartz ◽

...

Keyword(s):

Ulcerative Colitis ◽

Small Bowel ◽

Adverse Events ◽

Disease Activity ◽

Capsule Endoscopy ◽

Kappa Coefficient ◽

Conventional Colonoscopy ◽

Percent Agreement ◽

Colon Capsule Endoscopy ◽

Colon Capsule

Abstract Background and aims Diagnosis and monitoring of ulcerative colitis (UC) includes conventional colonoscopy. This procedure is invasive and does not exclude small-bowel Crohn’s disease (CD). Current therapeutic goals include mucosal healing which may lead to an increased number of endoscopic procedures in many patients. The small-bowel colon capsule endoscopy (SBC-CE) system visualizes the small bowel and colon. The aim of this study was to evaluate the performance and adverse events of SBC-CE in patients with UC. Methods This was a prospective, feasibility study involving two study sites. Patients with active UC underwent SBC-CE and colonoscopy. Kappa statistics were performed to assess the agreement between SBC-CE and colonoscopy. Adverse events (AEs) data were collected throughout and following the procedure. Results In total, 30 consecutive patients were recruited, and 23 of those were included in the final analysis. For the primary end point, evaluation of the extent of UC disease in the colon, the percent agreement between SBC-CE and colonoscopy was moderate (56.5 %); kappa coefficient 0.42. The percent agreement between SBC-CE and colonoscopy for UC disease activity, based on Mayo endoscopic sub-score, was 95.7 %; kappa coefficient 0.86. Disease activity in the more proximal small bowel was detected in two patients with SBC-CE. No SBC-CE device-related AEs were reported. Conclusions When comparing SBC-CE to conventional colonoscopy, there was a moderate agreement for the extent of UC disease and a very good overall agreement between the two modalities for UC disease activity.

Download Full-text

Colon Capsule Endoscopy vs. CT Colonography Following Incomplete Colonoscopy: A Systematic Review with Meta-Analysis

Cancers ◽

10.3390/cancers12113367 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3367

Author(s):

Ulrik Deding ◽

Lasse Kaalby ◽

Henrik Bøggild ◽

Eva Plantener ◽

Mie Kruse Wollesen ◽

...

Keyword(s):

Capsule Endoscopy ◽

Diagnostic Yield ◽

Meta Analysis ◽

Rate Sensitivity ◽

Completion Rate ◽

Polyp Detection ◽

Proximal Point ◽

Incomplete Colonoscopy ◽

Colon Capsule Endoscopy ◽

Colon Capsule

Following incomplete colonoscopy (IC) patients often undergo computed tomography colonography (CTC), but colon capsule endoscopy (CCE) may be an alternative. We compared the completion rate, sensitivity and diagnostic yield for polyp detection from CCE and CTC following IC. A systematic literature search resulted in twenty-six studies. Extracted data included inter alia, complete/incomplete investigations and polyp findings. Pooled estimates of completion rates of CCE and CTC and complete colonic view rates (CCE reaching the most proximal point of IC) of CCE were calculated. Per patient diagnostic yields of CCE and CTC were calculated stratified by polyp sizes. CCE completion rate and complete colonic view rate were 76% (CI 95% 68–84%) and 90% (CI 95% 83–95%). CTC completion rate was 98% (CI 95% 96–100%). Diagnostic yields of CTC and CCE were 10% (CI 95% 7–15%) and 37% (CI 95% 30–43%) for any size, 13% (CI 95% 9–18%) and 21% (CI 95% 12–32%) for >5-mm and 4% (CI 95% 2–7%) and 9% (CI 95% 3–17%) for >9-mm polyps. No study performed a reference standard follow-up after CCE/CTC in individuals without findings, rendering sensitivity calculations unfeasible. The increased diagnostic yield of CCE could outweigh its slightly lower complete colonic view rate compared to the superior CTC completion rate. Hence, CCE following IC appears feasible for an introduction to clinical practice. Therefore, randomized studies investigating CCE and/or CTC following incomplete colonoscopy with a golden standard reference for the entire population enabling estimates for sensitivity and specificity are needed.

Download Full-text

Meta-analysis Shows Colon Capsule Endoscopy Is Effective in Detecting Colorectal Polyps

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2010.02.018 ◽

2010 ◽

Vol 8 (6) ◽

pp. 516-522.e8 ◽

Cited By ~ 62

Author(s):

Cristiano Spada ◽

Cesare Hassan ◽

Riccardo Marmo ◽

Lucio Petruzziello ◽

Maria Elena Riccioni ◽

...

Keyword(s):

Capsule Endoscopy ◽

Meta Analysis ◽

Colorectal Polyps ◽

Colon Capsule Endoscopy ◽

Colon Capsule

Download Full-text

False positive at colon capsule endoscopy or false negative at conventional colonoscopy?

Endoscopy ◽

10.1055/s-0029-1244126 ◽

2010 ◽

Vol 42 (05) ◽

pp. 427-428 ◽

Cited By ~ 4

Author(s):

C. Spada ◽

C. Hassan ◽

M. Riccioni ◽

G. Costamagna

Keyword(s):

Capsule Endoscopy ◽

False Positive ◽

False Negative ◽

Conventional Colonoscopy ◽

Colon Capsule Endoscopy ◽

Colon Capsule

Download Full-text

A Meta-Analysis to Evaluate Results of Colon Capsule Endoscopy Trials

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2009.03.1129 ◽

2009 ◽

Vol 69 (5) ◽

pp. AB375

Author(s):

Theodore Rokkas ◽

Konstantinos Papaxoinis ◽

Konstantinos Triantafyllou ◽

Spiros D. Ladas

Keyword(s):

Capsule Endoscopy ◽

Meta Analysis ◽

Colon Capsule Endoscopy ◽

Colon Capsule

Download Full-text

PTU-222 A comparison of patient tolerance of bowel preparation regimens used for conventional colonoscopy, small bowel and colon capsule endoscopy

Gut ◽

10.1136/gutjnl-2012-302514c.222 ◽

2012 ◽

Vol 61 (Suppl 2) ◽

pp. A276.1-A276

Author(s):

K Drew ◽

S Hardcastle ◽

A J Lobo ◽

D S Sanders ◽

R Sidhu ◽

...

Keyword(s):

Small Bowel ◽

Capsule Endoscopy ◽

Bowel Preparation ◽

Conventional Colonoscopy ◽

Colon Capsule Endoscopy ◽

Patient Tolerance ◽

Colon Capsule

Download Full-text

Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review

Journal of Neurosurgery Spine ◽

10.3171/2015.2.spine14973 ◽

2016 ◽

Vol 24 (3) ◽

pp. 416-427 ◽

Cited By ~ 87

Author(s):

Christina L. Goldstein ◽

Kevin Macwan ◽

Kala Sundararajan ◽

Y. Raja Rampersaud

Keyword(s):

Systematic Review ◽

Adverse Event ◽

Adverse Events ◽

Minimally Invasive ◽

Comparative Effectiveness ◽

Meta Analysis ◽

Perioperative Outcomes ◽

Estimated Blood Loss ◽

Significant Difference ◽

Patient Reported

OBJECT The objective of this study was to determine the clinical comparative effectiveness and adverse event rates of posterior minimally invasive surgery (MIS) compared with open transforaminal or posterior lumbar interbody fusion (TLIF/PLIF). METHODS A systematic review of the Medline, EMBASE, PubMed, Web of Science, and Cochrane databases was performed. A hand search of reference lists was conducted. Studies were reviewed by 2 independent assessors to identify randomized controlled trials (RCTs) or comparative cohort studies including at least 10 patients undergoing MIS or open TLIF/PLIF for degenerative lumbar spinal disorders and reporting at least 1 of the following: clinical outcome measure, perioperative clinical or process measure, radiographic outcome, or adverse events. Study quality was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) protocol. When appropriate, a meta-analysis of outcomes data was conducted. RESULTS The systematic review and reference list search identified 3301 articles, with 26 meeting study inclusion criteria. All studies, including 1 RCT, were of low or very low quality. No significant difference regarding age, sex, surgical levels, or diagnosis was identified between the 2 cohorts (856 patients in the MIS cohort, 806 patients in the open cohort). The meta-analysis revealed changes in the perioperative outcomes of mean estimated blood loss, time to ambulation, and length of stay favoring an MIS approach by 260 ml (p < 0.00001), 3.5 days (p = 0.0006), and 2.9 days (p < 0.00001), respectively. Operative time was not significantly different between the surgical techniques (p = 0.78). There was no significant difference in surgical adverse events (p = 0.97), but MIS cases were significantly less likely to experience medical adverse events (risk ratio [MIS vs open] = 0.39, 95% confidence interval 0.23–0.69, p = 0.001). No difference in nonunion (p = 0.97) or reoperation rates (p = 0.97) was observed. Mean Oswestry Disability Index scores were slightly better in the patients undergoing MIS (n = 346) versus open TLIF/PLIF (n = 346) at a median follow-up time of 24 months (mean difference [MIS – open] = 3.32, p = 0.001). CONCLUSIONS The result of this quantitative systematic review of clinical comparative effectiveness research examining MIS versus open TLIF/PLIF for degenerative lumbar pathology suggests equipoise in patient-reported clinical outcomes. Furthermore, a meta-analysis of adverse event data suggests equivalent rates of surgical complications with lower rates of medical complications in patients undergoing minimally invasive TLIF/PLIF compared with open surgery. The quality of the current comparative evidence is low to very low, with significant inherent bias.

Download Full-text