Accuracy of First- and Second-Generation Colon Capsules in Endoscopic Detection of Colorectal Polyps: A Systematic Review and Meta-analysis

Cristiano Spada, Shabana F Pasha, Seth A. Gross, Jonathan A Leighton, Felice Schnoll-Sussman, Loredana Correale, Begoña González Suárez, Guido Costamagna, Cesare Hassan

Research output: Contribution to journalReview article

32 Citations (Scopus)

Abstract

Background & Aims Colon capsule endoscopy (CCE) is a noninvasive technique used to explore the colon without sedation or air insufflation. A second-generation capsule was recently developed to improve accuracy of detection, and clinical use has expanded globally. We performed a systematic review and meta-analysis to assess the accuracy of CCE in detecting colorectal polyps. Methods We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and other databases from 1966 through 2015 for studies that compared accuracy of colonoscopy with histologic evaluation with CCE. The risk of bias within each study was ascertained according to Quality Assessment of Diagnostic Accuracy in Systematic Reviews recommendations. Per-patient accuracy values were calculated for polyps, overall and for first-generation (CCE-1) and second-generation (CCE-2) capsules. We analyzed data by using forest plots, the I2 statistic to calculate heterogeneity, and meta-regression analyses. Results Fourteen studies provided data from 2420 patients (1128 for CCE-1 and 1292 for CCE-2). CCE-2 and CCE-1 detected polyps >6 mm with 86% sensitivity (95% confidence interval [CI], 82%–89%) and 58% sensitivity (95% CI, 44%–70%), respectively, and 88.1% specificity (95% CI, 74.2%–95.0%) and 85.7% specificity (95% CI, 80.2%–90.0%), respectively. CCE-2 and CCE-1 detected polyps >10 mm with 87% sensitivity (95% CI, 81%–91%) and 54% sensitivity (95% CI, 29%–77%), respectively, and 95.3% specificity (95% CI, 91.5%–97.5%) and 97.4% specificity (95% CI, 96.0%–98.3%), respectively. CCE-2 identified all 11 invasive cancers detected by colonoscopy. Conclusions The sensitivity in detection of polyps >6 mm and >10 mm increased substantially between development of first-generation and second-generation colon capsules. High specificity values for detection of polyps by CCE-2 seem to be achievable with a 10-mm cutoff and in a screening setting.

Original languageEnglish (US)
Pages (from-to)1533-1543.e8
JournalClinical Gastroenterology and Hepatology
Volume14
Issue number11
DOIs
StatePublished - Nov 1 2016

Fingerprint

Capsule Endoscopy
Polyps
Capsules
Meta-Analysis
Colon
Confidence Intervals
Colonoscopy
Insufflation
MEDLINE

Keywords

  • Colorectal Cancer
  • Colorectal Cancer Screening
  • Imaging
  • PillCam

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Accuracy of First- and Second-Generation Colon Capsules in Endoscopic Detection of Colorectal Polyps : A Systematic Review and Meta-analysis. / Spada, Cristiano; Pasha, Shabana F; Gross, Seth A.; Leighton, Jonathan A; Schnoll-Sussman, Felice; Correale, Loredana; González Suárez, Begoña; Costamagna, Guido; Hassan, Cesare.

In: Clinical Gastroenterology and Hepatology, Vol. 14, No. 11, 01.11.2016, p. 1533-1543.e8.

Research output: Contribution to journalReview article

Spada, Cristiano ; Pasha, Shabana F ; Gross, Seth A. ; Leighton, Jonathan A ; Schnoll-Sussman, Felice ; Correale, Loredana ; González Suárez, Begoña ; Costamagna, Guido ; Hassan, Cesare. / Accuracy of First- and Second-Generation Colon Capsules in Endoscopic Detection of Colorectal Polyps : A Systematic Review and Meta-analysis. In: Clinical Gastroenterology and Hepatology. 2016 ; Vol. 14, No. 11. pp. 1533-1543.e8.
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title = "Accuracy of First- and Second-Generation Colon Capsules in Endoscopic Detection of Colorectal Polyps: A Systematic Review and Meta-analysis",
abstract = "Background & Aims Colon capsule endoscopy (CCE) is a noninvasive technique used to explore the colon without sedation or air insufflation. A second-generation capsule was recently developed to improve accuracy of detection, and clinical use has expanded globally. We performed a systematic review and meta-analysis to assess the accuracy of CCE in detecting colorectal polyps. Methods We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and other databases from 1966 through 2015 for studies that compared accuracy of colonoscopy with histologic evaluation with CCE. The risk of bias within each study was ascertained according to Quality Assessment of Diagnostic Accuracy in Systematic Reviews recommendations. Per-patient accuracy values were calculated for polyps, overall and for first-generation (CCE-1) and second-generation (CCE-2) capsules. We analyzed data by using forest plots, the I2 statistic to calculate heterogeneity, and meta-regression analyses. Results Fourteen studies provided data from 2420 patients (1128 for CCE-1 and 1292 for CCE-2). CCE-2 and CCE-1 detected polyps >6 mm with 86{\%} sensitivity (95{\%} confidence interval [CI], 82{\%}–89{\%}) and 58{\%} sensitivity (95{\%} CI, 44{\%}–70{\%}), respectively, and 88.1{\%} specificity (95{\%} CI, 74.2{\%}–95.0{\%}) and 85.7{\%} specificity (95{\%} CI, 80.2{\%}–90.0{\%}), respectively. CCE-2 and CCE-1 detected polyps >10 mm with 87{\%} sensitivity (95{\%} CI, 81{\%}–91{\%}) and 54{\%} sensitivity (95{\%} CI, 29{\%}–77{\%}), respectively, and 95.3{\%} specificity (95{\%} CI, 91.5{\%}–97.5{\%}) and 97.4{\%} specificity (95{\%} CI, 96.0{\%}–98.3{\%}), respectively. CCE-2 identified all 11 invasive cancers detected by colonoscopy. Conclusions The sensitivity in detection of polyps >6 mm and >10 mm increased substantially between development of first-generation and second-generation colon capsules. High specificity values for detection of polyps by CCE-2 seem to be achievable with a 10-mm cutoff and in a screening setting.",
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author = "Cristiano Spada and Pasha, {Shabana F} and Gross, {Seth A.} and Leighton, {Jonathan A} and Felice Schnoll-Sussman and Loredana Correale and {Gonz{\'a}lez Su{\'a}rez}, Bego{\~n}a and Guido Costamagna and Cesare Hassan",
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T1 - Accuracy of First- and Second-Generation Colon Capsules in Endoscopic Detection of Colorectal Polyps

T2 - A Systematic Review and Meta-analysis

AU - Spada, Cristiano

AU - Pasha, Shabana F

AU - Gross, Seth A.

AU - Leighton, Jonathan A

AU - Schnoll-Sussman, Felice

AU - Correale, Loredana

AU - González Suárez, Begoña

AU - Costamagna, Guido

AU - Hassan, Cesare

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background & Aims Colon capsule endoscopy (CCE) is a noninvasive technique used to explore the colon without sedation or air insufflation. A second-generation capsule was recently developed to improve accuracy of detection, and clinical use has expanded globally. We performed a systematic review and meta-analysis to assess the accuracy of CCE in detecting colorectal polyps. Methods We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and other databases from 1966 through 2015 for studies that compared accuracy of colonoscopy with histologic evaluation with CCE. The risk of bias within each study was ascertained according to Quality Assessment of Diagnostic Accuracy in Systematic Reviews recommendations. Per-patient accuracy values were calculated for polyps, overall and for first-generation (CCE-1) and second-generation (CCE-2) capsules. We analyzed data by using forest plots, the I2 statistic to calculate heterogeneity, and meta-regression analyses. Results Fourteen studies provided data from 2420 patients (1128 for CCE-1 and 1292 for CCE-2). CCE-2 and CCE-1 detected polyps >6 mm with 86% sensitivity (95% confidence interval [CI], 82%–89%) and 58% sensitivity (95% CI, 44%–70%), respectively, and 88.1% specificity (95% CI, 74.2%–95.0%) and 85.7% specificity (95% CI, 80.2%–90.0%), respectively. CCE-2 and CCE-1 detected polyps >10 mm with 87% sensitivity (95% CI, 81%–91%) and 54% sensitivity (95% CI, 29%–77%), respectively, and 95.3% specificity (95% CI, 91.5%–97.5%) and 97.4% specificity (95% CI, 96.0%–98.3%), respectively. CCE-2 identified all 11 invasive cancers detected by colonoscopy. Conclusions The sensitivity in detection of polyps >6 mm and >10 mm increased substantially between development of first-generation and second-generation colon capsules. High specificity values for detection of polyps by CCE-2 seem to be achievable with a 10-mm cutoff and in a screening setting.

AB - Background & Aims Colon capsule endoscopy (CCE) is a noninvasive technique used to explore the colon without sedation or air insufflation. A second-generation capsule was recently developed to improve accuracy of detection, and clinical use has expanded globally. We performed a systematic review and meta-analysis to assess the accuracy of CCE in detecting colorectal polyps. Methods We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and other databases from 1966 through 2015 for studies that compared accuracy of colonoscopy with histologic evaluation with CCE. The risk of bias within each study was ascertained according to Quality Assessment of Diagnostic Accuracy in Systematic Reviews recommendations. Per-patient accuracy values were calculated for polyps, overall and for first-generation (CCE-1) and second-generation (CCE-2) capsules. We analyzed data by using forest plots, the I2 statistic to calculate heterogeneity, and meta-regression analyses. Results Fourteen studies provided data from 2420 patients (1128 for CCE-1 and 1292 for CCE-2). CCE-2 and CCE-1 detected polyps >6 mm with 86% sensitivity (95% confidence interval [CI], 82%–89%) and 58% sensitivity (95% CI, 44%–70%), respectively, and 88.1% specificity (95% CI, 74.2%–95.0%) and 85.7% specificity (95% CI, 80.2%–90.0%), respectively. CCE-2 and CCE-1 detected polyps >10 mm with 87% sensitivity (95% CI, 81%–91%) and 54% sensitivity (95% CI, 29%–77%), respectively, and 95.3% specificity (95% CI, 91.5%–97.5%) and 97.4% specificity (95% CI, 96.0%–98.3%), respectively. CCE-2 identified all 11 invasive cancers detected by colonoscopy. Conclusions The sensitivity in detection of polyps >6 mm and >10 mm increased substantially between development of first-generation and second-generation colon capsules. High specificity values for detection of polyps by CCE-2 seem to be achievable with a 10-mm cutoff and in a screening setting.

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KW - Colorectal Cancer Screening

KW - Imaging

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