Colon Capsule Endoscopy as an entry level test under the right circumstances

We read with interest a consensus statement of the ScotCap clinical leads collaboration reported by Macleod et al. on the use of Computer Tomography Colonography (CTC) and Colon Capsule Endoscopy (CCE) as promoted diagnostic modalities in the Covid-19 era and how to deal with diminutive and small polyps with a 'realistic medicine' approach (1). The issues discussed are important, and the suggestions made are essential to improve healthcare provision for patients, doctors, hospitals, and society. The number needed to colonoscope to find one significant neoplastic lesion has increased dramatically in recent years – in Denmark more than 4-fold in 15 years, whereas the number of cancers diagnosed has increased very modestly (20-30% in 15 years). In Europe alone, more than 12m colonoscopies are performed each year. Complications are primarily associated with therapeutic optical colonoscopies (OC); significant complications (bleeding, perforation and polypectomy syndrome) are seen in 0.7% and adding up to over 400.000 cases yearly (2).