Colon capsule endoscopy compared to conventional colonoscopy in patients with colonic diverticulitis: a randomised controlled superiority trial

Background and study aim: Follow-up colonoscopy after an episode with colonic diverticulitis (CD) is standard in the Danish healthcare system to exclude malignancy. Colon capsule endoscopy (CCE) is a diagnostic alternative to colonoscopy. The purpose of this study was to compare CCE with colonoscopy after an episode with CD with primary focus on patient-reported outcomes. Patients and methods: A randomised controlled trial was conducted in patients with CT-verified CD from Odense University Hospital. Patients were randomized to either CCE (PillCam Colon 2, Medtronic), or colonoscopy 4-6 weeks after discharge. Primary outcomes were patient-reported discomfort and examination preference. Secondary outcomes were proportion of complete examinations, need for further examination and frequency of polyp and CRC findings. Results: In total, 159 patients were included with 148 receiving their allocated intervention and 83 completing the questionnaires. Demographic data were comparable between the two groups, and no adverse events were observed. No significant difference in experienced physical and mental discomfort between CCE and colonoscopy was found. We observed a significantly higher median Visual Analog Scale (VAS) score for expected physical and mental discomfort for colonoscopy, compared with CCE. In case of a new event, 49% would prefer CCE, 13% would prefer colonoscopy and the remaining 38% did not know. Complete examinations were observed in 84% of CCEs and 92% of colonoscopies. No malignant lesions were found. Conclusions: CCE is a safe procedure for follow-up in patients after an episode with CD and is preferred by a majority of the patients compared to colonoscopy, but those receiving both modalities differed.