Colon capsule endoscopy versus computed tomographic colonography for identifying colorectal cancer and polyps: A systemic review and meta-analysis

ABSTRACT

Introduction: Colorectal Cancer is the third commonest cancer and ranks second in cancer-related deaths worldwide1. It is imperative to diagnose the condition in the initial stages for early treatment and improved outcomes. Colonoscopy is a gold standard investigation, but it is an invasive procedure and has failure and incompletion rates with risk of aerosol-generation2,3. Computed Tomographic Colonography, the second investigation, is limited by radiation exposure and aerosol generation3. Colon Capsule endoscopy is a novel technique without gas insufflation, therefore avoiding discomfort and aerosol generation. Current evidence favoured the CCE use, but the literature behind this is still in the infancy stages. Aims & Methods: This review aims to compare the yield of the CCE with CTC in CRC and polyps in patients with positive stool tests or diagnosed colorectal lesions. Review followed PRISMA standards. The electronic database searched for RCTs and observational studies. MedCalc Statistical Software version 17.2.1 used for the synthesis of results4. Primary (Per-Lesion and Per-Patient sensitivity analysis) and secondary (Other lesion and completion rate sensitivity analysis) outcomes measured using a random-effect model. Results: We found one RCT and three prospective observational studies (Fig 1), enrolling a total of 237 patients. Per-Lesion Sensitivity Analysis of CCE versus CTC showed overall effect of 1.903 (0.990- 1.937), p-value-0.057 (Fig 2). Per-Patient Sensitivity Analysis showed overall effect of 1.928 (0.995-1.892), p-value-0.054 (Fig 3). Other lesions Sensitivity Analysis showed overall effect of 0.810 (0.121-161.995), p-value-0.418. Completion Rate Sensitivity Analysis showed overall effect of -0.419 (0.526-1.516), p-value-0.676. None of the primary and secondary outcomes showed significant results between CCE and CTC. Conclusion: CCE had a better detection rate for colorectal cancer and polyp than the CTC, but this was not statistically significant. Therefore, this study failed to prove CCE's superiority over CTC. Considerable variability noted in the included studies with the inadequate quality and lacunae in the data. Initial studies revealed promising results of CCE, but they had a low level of evidence. A careful decision must be taken in the current COVID-19 pandemic since its advantage of zero aerosolisation. Researchers should focus on innovation in techniques and simultaneous high-quality studies to evaluate them.