Möllers Tobias, Schwab Matthias, Gildein Lisa, Hoffmeister Michael, Albert Jörg, Brenner Hermann, Jäger Simon
Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre, Heidelberg, Germany.
Dr. Margarete Fischer Bosch Institute of Clinical Pharmacology, Clinical Pharmacogenomics and Cancer, Stuttgart, Germany.
Endosc Int Open. 2021 Apr;9(4):E562-E571. doi: 10.1055/a-1353-4849. Epub 2021 Apr 12.
Adherence to colorectal cancer (CRC) screening is still unsatisfactory in many countries, thereby limiting prevention of CRC. Colon capsule endoscopy (CCE), a minimally invasive procedure, could be an alternative to fecal immunochemical tests or optical colonoscopy for CRC screening, and might increase adherence in CRC screening. This systematic review and meta-analysis evaluates the diagnostic accuracy of CCE compared to optical colonoscopy (OC) as the gold standard, adequacy of bowel preparation regimes and the patient perspective on diagnostic measures. We conducted a systematic literature search in PubMed, EMBASE and the Cochrane Register for Clinical Trials. Pooled estimates for sensitivity, specificity and the diagnostic odds ratio with their respective 95 % confidence intervals (CI) were calculated for studies providing sufficient data. Of 840 initially identified studies, 13 were included in the systematic review and up to 9 in the meta-analysis. The pooled sensitivities and specificities for polyps ≥ 6 mm were 87 % (95 % CI: 83 %-90 %) and 87 % (95 % CI: 76 %-93 %) in 8 studies, respectively. For polyps ≥ 10 mm, the pooled estimates for sensitivities and specificities were 87 % (95 % CI: 83 %-90 %) and 95 % (95 % CI: 92 %-97 %) in 9 studies, respectively. A patients' perspective was assessed in 31 % (n = 4) of studies, and no preference of CCE over OC was reported. Bowel preparation was adequate in 61 % to 92 % of CCE exams. CCE provides high diagnostic accuracy in an adequately cleaned large bowel. Conclusive findings on patient perspectives require further studies to increase acceptance/adherence of CCE for CRC screening.
在许多国家，结直肠癌（CRC）筛查的依从性仍然不尽人意，从而限制了结直肠癌的预防。结肠胶囊内镜检查（CCE）是一种微创手术，可作为粪便免疫化学检测或光学结肠镜检查用于CRC筛查的替代方法，可能会提高CRC筛查的依从性。本系统评价和荟萃分析评估了与作为金标准的光学结肠镜检查（OC）相比，CCE的诊断准确性、肠道准备方案的充分性以及患者对诊断措施的看法。我们在PubMed、EMBASE和Cochrane临床试验注册库中进行了系统的文献检索。对提供足够数据的研究计算了敏感性、特异性和诊断比值比及其各自的95%置信区间（CI）的合并估计值。在最初识别的840项研究中，13项纳入了系统评价，最多9项纳入了荟萃分析。8项研究中，息肉≥6mm的合并敏感性和特异性分别为87%（95%CI：83%-90%）和87%（95%CI：76%-93%）。对于息肉≥10mm，9项研究中合并敏感性和特异性的估计值分别为87%（95%CI：83%-90%）和95%（95%CI：92%-97%）。31%（n = 4）的研究评估了患者的看法，未报告CCE比OC更受青睐。61%至92%的CCE检查肠道准备充分。CCE在清洁充分的大肠中具有较高的诊断准确性。关于患者看法的确切结论需要进一步研究，以提高CCE用于CRC筛查的接受度/依从性。
