Higher income and certain behavioral factors were associated with greater likelihood of completing a colon capsule examination among colorectal cancer screening participants, while severe obesity and recent constipation or laxative use were linked to incomplete exams, according to a cross-sectional analysis of the CareForColon2015 trial published in BMJ Open Gastroenterology.
Investigators in Southern Denmark conducted the trial between August 2020 and December 2022 to evaluate colorectal cancer screening performance when participants were allowed to choose between capsule colon examination and colonoscopy. For this analysis, trial data were combined with Danish national registry data. The study included adults aged 50 to 75 years who selected capsule examination after receiving a screening invitation.
Among 1,472 participants with complete data, 69% achieved a complete examination. Completion required visualization of the anal or cecal landmarks or confirmed capsule excretion, no major technical interruptions, and adequate bowel cleansing in all segments. Inadequate bowel preparation accounted for most incomplete studies and occurred in about 24% of cases.
In adjusted analyses, higher income was independently associated with greater likelihood of completion. Participants in the highest income group had nearly twice the odds of completing the examination compared with those in the lowest income group. The association remained significant across increasing income levels.
Current smokers and participants reporting weekly alcohol intake of 15 or more units also had higher odds of completion compared with non-consumers.
In contrast, a body mass index of 40 or higher was associated with substantially lower likelihood of completion compared with a body mass index of 18.5 to less than 25. Participants who reported constipation during the week before the procedure or regular laxative use were also less likely to complete the examination. Use of pain medication was associated with lower completion rates in unadjusted analyses but did not remain significant after adjustment.
Sex, age, education level, exercise, coffee intake, stool form category, fecal immunochemical test concentration, and comorbidity burden were not significantly associated with completion in multivariable models.
The investigators noted that the trial was not specifically powered for subgroup analyses and that some subgroups were small. Because participants chose capsule examination instead of colonoscopy, selection bias may have influenced the findings. In addition, some data, including alcohol and medication use, were self-reported.
The authors wrote that the findings provide “essential knowledge for clinicians when considering the use of [colon capsule examination] and for the future development of a predictor model of qualified patients.” They added that further research, including systematic reviews and interventional studies aimed at improving completion rates, is needed.
The study was funded by Aage and Johanne Louis-Hansen’s Fond, Odense University Hospital’s innovation fund, the Medtronic Research Foundation, the Danish Cancer Society, and the Health Care Region of Southern Denmark. The first author also received support from the Novo Nordisk Scholarship and Agnethe Løvgreens Legat. One author reported being a co-founder and co-owner of a company related to capsule endoscopy; additional disclosures are available in the original publication.
Source: BMJ Open Gastroenterology