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Colorectal cancer is the leading cause of death worldwide [1], and increased incidence in the Japanese population [2] with Westernized-Japanese diet habits. Today, it is the first leading cause of cancer deaths in women and the second for both men and women in Japan [3]. Japanese CRC screening programs for colorectal cancer based on fecal occult blood testing (FOBT) started in 1992. It is an annual two-day FOBT method, and offered to those 40 years of age and over, and a total colonoscopy is performed for those with at least one positive FOBT [4]. There has been sufficient evidence of colorectal cancer screening programs using FOBT and colonoscopy reducing the motility of CRC [5]. However, participation rates are only 41.4% for men and 34.5% for women in Japan so far [6]. There may be several reasons the recommended colonoscopy is refused, including perceptions of discomfort, pain, or being worried about anal intubations especially for women, and the invasive nature of colonoscopies that include perforations and bleeding. Recently, the second-generation colon capsule endoscopy (CCE) (PillCam Colon 2: Medtronic Minneapolis, USA) began to be covered by Japanese health insurance. It is an easy and non-invasive method for screening colorectal cancer and only involves swallowing a capsule. Thus, this newer CCE is thought to be useful for detecting colorectal lesions in patients with FOBT who are unsuitable or unwilling to undergo a colonoscopy. However, to our knowledge, there have been no reports so far on the role of CCE in the FOBT-based Japanese population cohort. Therefore, in this article, we will review the current works of literature and present our trials on this issue in Japan.

Colon capsule endoscopy for colorectal cancer screening in patients with the positive fecal occult blood test (FOBT) in Japan