Factors Affecting Completion Rate and Bowel Cleansing Quality in a Colon Capsule Endoscopy Cohort: Comparing AI and Manual Evaluations

In the trial CareForColon2015 (CFC2015) we included more than 2000 colon cancer screening participants for colon capsule endoscopy (CCE). We detected distinct fluctuations in the rate of complete investigations defined as CCE with both complete transit and adequate bowel cleansing. We aimed to investigate possible contributing factors to incomplete investigations and compare fluctuations in manual and artificial intelligence (AI) generated cleansing evaluations. We retrieved CCE videos and relevant information from CFC2015. We considered the following factors as possible contributors to completion rate fluctuations: different outpatient clinics for CCE, individual nurses instructing participants, number of participants at the information session, timing of the last dose of bowel preparation, timing of capsule ingestion, time gap between the last dose of bowel preparation and capsule ingestion, manual CCE reader-cleansing evaluations. During the trial, the prokinetic prucalopride was added to the regimen. We compared the completion rates between different time periods of the trial. Monthly completion rates ranges from 56.6% to 75.7%. The fluctuations were caused by variation in cleansing quality and not in the proportion of complete transit. Early capsule ingestion showed increased odds of a complete investigation. The timing of the last dose of bowel preparation was associated with cleansing quality. Fluctuations in cleansing quality were detected by manual reading in all colonic segments but by the AI algorithm predominantly in the right colon. Timing of bowel preparation and capsule ingestion is an important factor for the bowel cleansing quality in CCE. Using AI for cleansing quality monitoring in a CCE cohort can be an important measure for early identification of changes. Trial Registration: ClinicalTrials.gov: NCT04049357.