Colon capsule endoscopy compared with conventional colonoscopy in patients with colonic diverticulitis: a randomized controlled superiority trial on patient-reported outcomes

Background In the Danish health care system, follow-up colonoscopy is standard after a colonic diverticulitis episode in order to exclude malignancy. Colon capsule endoscopy (CCE) is a diagnostic alternative to colonoscopy. This study compared patient-reported outcomes of CCE versus colonoscopy after diverticulitis episodes. Methods A randomized controlled trial was conducted in patients with computed tomography-verified diverticulitis from Odense University Hospital. Patients were randomized to either CCE or colonoscopy 4-6 weeks after discharge. The primary outcome was patient-reported experienced physical and mental discomfort related to the procedures. Secondary outcomes were expected physical and mental discomfort, examination preference, proportion of complete examinations, and frequency of polyps and colorectal cancer. Results 159 patients were randomized, with 148 receiving their allocated intervention and 83 completing the questionnaires. Demographic data were comparable between the two groups. No adverse events were observed. Patients expected greater physical and mental discomfort with colonoscopy than with CCE. However, no significant difference was found in experienced physical and mental discomfort between CCE and colonoscopy. For hypothetical future events, 49% of patients would prefer CCE, 13% would prefer colonoscopy, and 38% did not know. Complete examinations were reported for 84% of CCEs and 92% of colonoscopies. No malignant lesions were found. Conclusions CCE was a safe follow-up procedure after a diverticulitis episode. CCE was preferred to colonoscopy by most patients who reported their experience. No difference was observed regarding experienced physical and mental discomfort between the groups completing the questionnaires.