From capsule to scope: predicting colon capsule endoscopy conversion to optical endoscopy – insights from the CESCAIL study

Lee, Tom

From capsule to scope: predicting colon capsule endoscopy conversion to optical endoscopy – insights from the CESCAIL study

Authors

Lee, Tom

Issue Date

2025

Type

Presentation

Language

en

Keywords

CESCAIL , bowel cancer , colon capsule endoscopy (CCE) , CCE-to-conventional colonoscopy conversion (CCC) , colonoscopy , endoscopy

Abstract

Background: Colon capsule endoscopy (CCE) has emerged as a non-invasive alternative to traditional colonoscopy for low-risk patients. However, its adoption is limited by low completion rates and the inability to perform biopsies or polyp removal, often resulting in CCE-to-conventional colonoscopy conversion (CCC). This conversion carries financial implications, contributes to patient dissatisfaction due to repeated procedures, and imposes a potential environmental burden from increased hospital visits. Objective(s): The aim is to identify the factors that predict issues with bowel cleansing, capsule excretion rates, pathology detection, and the need for CCC. Methods: In this prospective analysis of the CESCAIL study (November 2021–June 2024), 603 patients who underwent CCE were included. Predictive factors—including patient demographics, comorbidities, medications, and laboratory results—were analysed across symptomatic and surveillance groups. Statistical techniques such as LASSO regression, linear regression, and logistic regression were applied. Results: Among the 603 participants analyzed, elevated f-Hb levels (OR=1.48, 95% CI: 1.18–1.86, p=0.0002) and smoking (OR=1.44, 95% CI: 1.01–2.11, p=0.047) were significantly associated with CCE-to-conventional colonoscopy conversion (CCC). However, an AUC of 0.62 after adjusting for confounders suggests f-Hb is a weak predictor of CCC. Diabetes was linked to poor bowel preparation (OR=0.40, 95% CI: 0.18–0.87, p=0.022). Alcohol use (p=0.004), smoking (p=0.003), and psychological conditions (p=0.001) were significantly associated with an increased polyp count, while haemoglobin levels (p=0.046) showed a marginal negative association with polyp numbers. Additionally, antidepressants (p=0.003) were associated with larger polyps, whereas beta-blockers (p=0.001) were linked to smaller polyps. Conclusion: Non-smokers with lower f-Hb levels are less likely to require CCC. Effective patient selection criteria are essential for minimising conversion rates and improving the efficiency of CCE services. These findings highlight the need for validation across diverse populations to develop a CCE Conversion Scoring System (CECS), ultimately enhancing cost-effectiveness and ensuring CCE becomes a sustainable clinical service.

Journal

Gut