key: cord-0748172-08q670xl
authors: Dockter, Andrew Grayson; Angelos, George C.
title: Stool‐Based DNA testing versus Colon Capsule Endoscopy for colorectal cancer screening during the COVID‐19 Pandemic, a correspondence letter to “Colon capsule endoscopy: an innovative method for detecting colorectal pathology during the COVID‐19 pandemic?”
date: 2020-08-14
journal: Colorectal Dis
DOI: 10.1111/codi.15312
sha: a03ca4481dafb60f000cb530673594c66b90c2e3
doc_id: 748172
cord_uid: 08q670xl

We applaud the ingenuity of MacLeod et al. (2020) for their insight on the potential of capsule endoscopy as an alternative colon cancer screening and diagnostic modality. We have similarly been committed to approaching this dilemma in the context of scarce resources as well as risks inherent to the COVID‐19 pandemic. However, we did not include colon capsule endoscopy (CCE) in our discussion and commend the authors for their ingenuity.

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The current literature, including systematic reviews and metanalyses, does support colon capsule endoscopy (CCE) as a potential non-invasive technique for colon cancer screening. A prospective clinical trial by Rex et al., showed in an average-risk screening population, that capsule colonoscopy identified patients with one or more conventional adenomas 6 mm or larger with 88% sensitivity and 82% specificity [3] .

The findings from the DeeP-C cross-sectional study compared multitarget stool DNA with faecal immunological test with colonoscopy as the reference standard [4] . According to Imperiale et al.,

using multitarget stool DNA tests, the sensitivity for detecting colorectal cancer was 92.3% and specificity was 86.6%, the sensitivity for detecting advanced adenomas was 42.4%, and detection of polyps with high-grade dysplasia was 69.2% [4] .

There are significant limitations to CCE, including associated complications that may occur [5] . Prior abdominal surgery, suspected bowel obstruction, possibly from a colonic mass, or stricture lesions, especially associated with inflammatory bowel disease, would not allow CCE to be a viable option due to the risk of capsule retention, obstruction, and possible bowel perforation [5] .

Another limitation to CCE in the setting of the COVID-19 pandemic would be the need for experienced and trained physicians to provide accurate and timely results. Following from this, is the cost of CCE. The average cost of CCE is estimated at $950 or €700 [5] . For comparison, the average cost of Cologuard TM , is approximately $600. Multitarget DNA stool tests are safer, more costeffective, are more readily accessible, and easier for patient use in comparison to CCE. These aspects of multitarget DNA stool tests make it more efficacious as an alternative screening modality for colorectal cancer, in the setting of the COVID-19 pandemic.

Due to the cost, risk, and other alternatives, CCE should not be considered an alternative to screening colonoscopy during the current pandemic. We suggest it only be considered a surrogate for diagnostic colonoscopy and only in the setting of positive multitarget DNA stool test and patency capsule studies, if conventional colonoscopy is prohibitive. This is a very interesting opportunity to potentially improve the algorithm for high risk patients and screening for colon and rectal cancer:

1. Colonoscopy when appropriate as gold standard Accepted Article

Colon capsule endoscopy: an innovative method for detecting colorectal pathology during the COVID-19 pandemic? Colorectal Dis

Molecular-based Alternatives for Colorectal Cancer Screening during the COVID-19 Pandemic

Accuracy of capsule colonoscopy in detecting colorectal polyps in a screening population

Multitarget stool DNA testing for colorectal-cancer screening