Background: There are a number of reports that demonstrate the high diagnostic accuracy of colon capsule endoscopy (CCE) for polyp detection. However, some colorectal polyps are missed on CCE, and the clinical factors influencing those missed polyps are still unknown. Objective: The aim of this study was to elucidate the clinical factors related to missing colorectal polyp on CCE by using per-polyp analysis. Methods: We performed a retrospective multi-center study of 53 consecutive patients who underwent both CCE and colonoscopy (CS) within 3 months from January 2014 to ­December 2017. Of those patients, we analyzed 151 polyps detected on CCE, and 149 polyps detected on CS diagnosed as neoplasm according to histopathological result. Results: The capsule excretion rate was 81%. One hundred three polyps were detected on both CS and CCE, 46 polyps (31%) were missed on CCE, and 48 polyps were considered false positive on CCE when CS result was considered as the gold standard. Per-polyp sensitivity and positive predictive value on CCE were 69.1 and 68%. On multiple logistic analysis, only the segmental transit time on CCE was identified as the independent factor influencing missed polyp on CCE. Conclusions: The clinical factor related to missing colorectal polyp on CCE was the segmental transit time.

1.
Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012 Feb; 366(8): 687–96. 1Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012 Feb; 366(8): 687–96.
2.
Negreanu L, Babiuc R, Bengus A, Sadagurschi R. PillCam Colon 2 capsule in patients unable or unwilling to undergo colonoscopy. World J Gastrointest Endosc. 2013 Nov; 5(11): 559–67.
3.
Eliakim R, Fireman Z, Gralnek IM, Yassin K, Waterman M, Kopelman Y, et al. ­Evaluation of the PillCam Colon capsule in the detection of colonic pathology: results of the first multicenter, prospective, comparative study. Endoscopy. 2006 Oct; 38(10): 963–70.
4.
Schoofs N, Devière J, Van Gossum A. PillCam colon capsule endoscopy compared with colonoscopy for colorectal tumor diagnosis: a prospective pilot study. Endoscopy. 2006 Oct; 38(10): 971–7.
5.
Van Gossum A, Munoz-Navas M, Fernandez-Urien I, Carretero C, Gay G, Delvaux M, et al. Capsule endoscopy versus colonoscopy for the detection of polyps and cancer. N Engl J Med. 2009 Jul; 361(3): 264–70.
6.
Sieg A, Friedrich K, Sieg U. Is PillCam COLON capsule endoscopy ready for colorectal cancer screening? A prospective feasibility study in a community gastroenterology practice. Am J Gastroenterol. 2009 Apr; 104(4): 848–54.
7.
Spada C, Riccioni ME, Petruzziello L, Marchese M, Urgesi R, Costamagna G. The new PillCam Colon capsule: difficult colonoscopy? No longer a problem? Gastrointest Endosc. 2008 Oct; 68(4): 807–8.
8.
Tal AO, Vermehren J, Albert JG. Colon capsule endoscopy: current status and future directions. World J Gastroenterol. 2014 Nov; 20(44): 16596–602.
9.
Eliakim R, Yassin K, Niv Y, Metzger Y, Lachter J, Gal E, et al. Prospective multicenter performance evaluation of the second-generation colon capsule compared with colonoscopy. Endoscopy. 2009 Dec; 41(12): 1026–31.
10.
Spada C, Hassan C, Galmiche JP, Neuhaus H, Dumonceau JM, Adler S, et al.; European Society of Gastrointestinal Endoscopy. Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2012 May; 44(5): 527–36.
11.
Rex DK, Adler SN, Aisenberg J, et al. Accuracy of PillCam COLON 2 for detecting subjects with adenomas ≧6 mm. Gastrointest Endosc. 2013; 77:AB29.
12.
Kim NH, Jung YS, Jeong WS, Yang HJ, Park SK, Choi K, et al. Miss rate of colorectal neoplastic polyps and risk factors for missed polyps in consecutive colonoscopies. Intest Res. 2017 Jul; 15(3): 411–8.
13.
Wong MC, Ching JY, Chan VC, Lam TY, Luk AK, Tang RS, et al. Determinants of bowel preparation quality and its association with adenoma detection: A prospective colonoscopy study. Medicine (Baltimore). 2016 Jan; 95(2):e2251.
14.
Participants in the Paris Workshop. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003 Dec; 58(6 Suppl):S3–43.
15.
Zhou J, Tang X, Wang J, Chen Z, Wang X, Jiang B. Feasibility of a novel low-volume and sodium phosphate-free bowel preparation regimen for colon capsule endoscopy. Exp Ther Med. 2017 Aug; 14(2): 1739–43.
16.
Spada C, Barbaro F, Andrisani G, Minelli Grazioli L, Hassan C, Costamagna I, et al. Colon capsule endoscopy: what we know and what we would like to know. World J Gastroenterol. 2014 Dec; 20(45): 16948–55.
17.
Adler SN, Metzger YC, Roesch T. The flat polyp: does too much flattening occur with full air insufflation on colonoscopy? Endoscopy. 2010; 42(S 02 Suppl 2):E167–8.
18.
Sato J, Nakamura M, Watanabe O, Yamamura T, Funasaka K, Ohno E, et al. Prospective study of factors important to achieve observation of the entire colon on colon capsule endoscopy. Therap Adv Gastroenterol. 2017 Jan; 10(1): 20–31.
19.
Hotta N. The Use of Castor Oil for Bowel Preparation for Colon Capsule Endoscopy. J Med Imaging (Bellingham). 2016; 06: 103–7.
You do not currently have access to this content.