Summary

Colon capsule endoscopy (CCE) is used to examine the colon lining to identify colorectal polyps and cancer.

The intended place of CCE in the care pathway is as a triage tool for people referred for a colonoscopy. In Scotland, people are referred for a colonoscopy if they have:

    ▪ signs or symptoms of colorectal polyps or cancer (symptomatic population)

    ▪ a history of positive findings on a previous colonoscopy (surveillance population)

    ▪ a family history of colorectal polyps or cancer (surveillance population).

New evidence published since the SHTG recommendations in 2020 includes five meta-analyses and a systematic review assessing the diagnostic accuracy of CCE, an evaluation of the ScotCap service in northern Scotland, and evidence on patient experiences and preferences around bowel screening. The new evidence on CCE reports:

    ▪ sensitivity of 84% to 88% and specificity of 87% to 94% for the detection of polyps >6mm

    ▪ low adverse event rates

    ▪ patient views on acceptability that are comparable with those of colonoscopy.

An update to the 2020 SHTG cost analysis found that CCE is marginally cost saving in the symptomatic population because the costs of providing CCE are offset by a reduction in colonoscopies. CCE was found to be cost incurring in the surveillance population.

The evidence within this IMTO should be considered alongside the 2020 SHTG recommendations. Updating the SHTG recommendation would require an appraisal of the new evidence, clarification of the degree of overlap in studies within the meta-analyses and more detailed exploration of uncertainties in the cost analysis.

Referred by

The Accelerated National Innovation Adoption (ANIA) pathway