A prospective multicenter study published in Therapeutic Advances in Gastrointestinal Endoscopy evaluated whether colon capsule endoscopy (CCE) could serve as a practical alternative for FIT-positive individuals who are unable or unwilling to undergo colonoscopy within a national colorectal cancer screening program.
While CCE demonstrated a high per-patient polyp detection rate (77% for lesions ≥6 mm), real-world feasibility proved limited. More than half of eligible FIT-positive patients were excluded due to comorbidities or contraindications, bowel preparation quality was adequate in fewer than 40% of cases, and only 69% of procedures were complete within battery life. Importantly, most patients still required follow-up colonoscopy, limiting CCE’s ability to function as a true standalone alternative.
The study highlights a key mismatch: FIT-positive patients represent a higher-risk, higher-comorbidity population, precisely where CCE faces its greatest operational and clinical challenges. Although CCE detected advanced pathology—including one obstructing colorectal cancer—its frequent need for downstream endoscopy, combined with prep limitations and exclusions, undermines its utility in this setting.