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N obody looks forward to a colonoscopy, so a more convenient and noninvasive alternative might boost colorectal cancer screening rates — or so the argument goes. One such alternative is capsule endoscopy. Patients who undergo this procedure swallow a disposable capsule outfitted with a pair of cameras and a wireless transmitter. The device, known as PillCam, shoots roughly 50,000 images during a trip through the colon. Those images are collected by an external recorder and then compressed by software into a diagnostic video. PillCam’s ability to detect colon polyps or cancer doesn’t compare well to that of colonoscopy, however. And because of that, its use for cancer screening remains controversial. The method has regulatory approval in countries in Europe, Asia, and Latin America, according to its manufacturer, Given Imaging, in Yokneam, Israel. But health systems don’t pay the $1,150 cost even in these countries, said Michael Bretthauer, M.D., Ph.D., an editorial fellow at the New England Journal of Medicine who is currently on leave from Rikshospitalet University Hospital in Norway. PillCam was denied approval by the U.S. Food and Drug Administration in February 2008. Now, the results of a European multicenter study comparing PillCam and colonoscopy, published in the New England Journal of Medicine in July, are further dividing gastroenterologists. PillCam’s sensitivity — or its ability to detect polyps that were also detected by colonoscopy — averaged just 42% among subjects with poor bowel preparation and 72% for those with good to excellent preparation. In all, PillCam identifi ed 14 of 19 malignant tumors revealed by colonoscopy, and it often missed larger polyps in excess of 10 mm, which can easily progress to cancer.

Capsule Endoscopy To Screen for Colon Cancer Scores Low on Sensitivity, High on Controversy