Abstract Background Colon capsule endoscopy (CCE) has been proposed as a non-invasive alternative to colonoscopy for colorectal cancer (CRC) screening, offering greater patient comfort and potentially reducing healthcare burden. However, its cost-effectiveness in population-based screening remains uncertain. Methods This study used a state-transition (Markov) model to simulate lifetime outcomes of CRC screening in Denmark, Scotland, and Spain, comparing the standard pathway based on fecal immunochemical testing (FIT) followed by colonoscopy with an alternative pathway replacing colonoscopy with CCE after a positive FIT result. The model incorporated costs (2024 euros), quality-adjusted life-years (QALYs), and CRC cases avoided, applying a yearly discount rate of 3%. Deterministic sensitivity analyses explored uncertainty in capsule cost, adherence, and reinvestigation rates for non-advanced polyps. Results Across all settings, CCE resulted in higher costs but slightly increased effectiveness and utility (mean QALYs 28.7 vs. 28.8; CRC detected 0.032–0.034 vs. 0.035–0.037 per person). Incremental cost-effectiveness ratios (ICER) ranged from €43,538 in Spain to €136,930 in Denmark per additional CRC detected. Capsule cost was the main driver of ICER variation, whereas adherence rates had minimal effect on cost-effectiveness. Changes in the prevalence of non-advanced polyps had a modest impact, except when capsule prices were high. Conclusions Overall, replacing colonoscopy with CCE slightly increases detection and health gains at the expense of higher costs. Cost-effectiveness largely depends on capsule price and adherence. Artificial intelligence-assisted CCE interpretation may further improve diagnostic and economic performance, potentially supporting adoption in large-scale CRC screening programs.

IntroductionIncreasing demand for colonoscopy continues to strain healthcare systems worldwide. Colon capsule endoscopy (CCE) offers a minimally invasive alternative, but its adoption is limited by high re-investigation rates. The aim of this study is to develop and evaluate clinical prediction models for selecting faecal immunochemical test (FIT) positive patients most suitable for CCE versus colonoscopy.MethodsWe conducted a secondary analysis of data from CareForColon2015 randomized controlled trial (2020-2022), including individuals aged 50-74 years with a positive FIT. Logistic regression models were developed to predict CCE transit, bowel cleansing, completeness, and colonoscopy indication. Sixty candidate predictors were assessed, including demographics, lifestyle factors, FIT values, medications, perceived stress, and health literacy. Models were validated using repeated random subsampling and evaluated on a 10% hold-out set using the area under the receiver-operating-characteristic curve (AUC), Cohen's K, and accuracy. Decision curve analysis (DCA) was performed to assess clinical utility.ResultsCCE achieved complete transit in 92.1% and acceptable bowel cleansing in 71.3% of participants, with 69.6% of investigations deemed complete. Colonoscopy was indicated in 68.0% of cases, based on broad inclusion criteria, and 55.9%, based on more stringent criteria. Models predicting colonoscopy indication showed moderate performance (AUC 0.69-0.71; accuracy 65-67%; Cohen's K 0.28-0.30). DCA indicated positive net benefit for both models within threshold probabilities of 0.5-0.75, supporting their potential to identify FIT-positive patients unlikely to benefit from immediate colonoscopy.ConclusionsClinical prediction models may assist in post-FIT triage between CCE and colonoscopy. DCA suggests potential to reduce unnecessary colonoscopies by identifying low-risk patients suitable for initial CCE. External validation is needed before clinical implementation.

BACKGROUND AND AIM:Colon capsule endoscopy (CCE) is a noninvasive technique for colon evaluation. Although previous research has demonstrated high accuracy of CCE in detecting polyps, the impact of colonic transit time (CTT) on polyp detection remains unclear. We aimed to identify the lowest acceptable CTT for an optimal polyp detection rate (PDR). METHODS:This study analyzed data from colorectal cancer screening participants with complete CCE examinations, as part of the CareForColon2015 trial. A multivariate logistic regression model was employed to investigate the relationship between CTT and PDR. RESULTS:Among the 2,031 participants who underwent CCE, 1,266 (62.3%) were eligible for analysis. CTTs ≤ 20 minutes were significantly associated with lower PDR for polyps of any size (OR 0.36, 95% CI 0.22; 0.59, P < .001) and polyps > 5 mm (OR 0.54, 95% CI 0.34; 0.85, P = .007) compared to a CTT of > 60 minutes. A nonsignificant trend was observed for CTTs 21-40 minutes and PDR for polyps > 5 mm (OR 0.68, 95% CI 0.46; 1.01, P = .053). No significant differences in PDR for polyps > 9 mm was found across the CTT categories. A sensitivity analysis with size-adjusted polyps revealed no significant differences in PDR for polyps > 5 mm across CTT categories. CONCLUSIONS:CTTs of ≤ 20 min are correlated with lower PDR for polyps of any size and those exceeding > 5 mm, but not for polyps > 9 mm. After size-adjustments of polyps, detection rates of clinically significant polyps were deemed CTT independent.

Objective Incomplete investigations challenge the clinical use of colon capsule endoscopy (CCE). This results in added cost to healthcare systems and added discomfort to patients. In order to potentially lower the re-investigation rate, we aimed to investigate the association between multiple patient characteristics and complete CCE.Methods In 2020, the CareForColon2015 (CFC2015) Trial was initiated in the Region of Southern Denmark, investigating the performance of CCE in colorectal cancer screening. Data from the CFC2015 Trial were combined with data from multiple national registers. Completion rates were calculated and their relation to the different patient characteristics was analysed in univariate and multivariate logistic regression models.Results We analysed 1472 participants, of whom 1016 (69.1%) had complete investigations. We investigated the associations between 17 patient characteristics and complete CCE investigation. The multivariate analysis showed that smokers and heavy drinkers had a higher probability of a complete investigation, with ORs of 1.69 (95% CI 1.12 to 2.55) and 2.72 (95% CI 1.52 to 4.87), respectively, compared with non-consumers. We also found that increasing income was associated with increased odds of CCE completion (OR 1.78, 95% CI 1.30 to 2.43, for the highest quartile). High body mass index (>40) and self-reported constipation or laxative use were significantly associated with incomplete CCE, with ORs of 0.40 (95% CI 0.17 to 0.97) and 0.65 (95% CI 0.47 to 0.90), respectively.Conclusion This study tested multiple factors for association with CCE completion. The results indicate that some factors are associated with higher odds of completion, while others are associated with lower odds of completion. These results confirm that specific patient characteristics correlate with the odds of complete investigation. This can, in turn, be used to determine the individual diagnostic pathway. Additional studies are needed for less frequently reported characteristics and to further support these findings.

Background: Endoscopy units throughout the world have seen a substantial increase in colonoscopy activity. One way to keep patient waiting time acceptable could be to introduce alternative diagnostic modalities. Colon capsule endoscopy has been proven to have a high diagnostic accuracy, yet the re-investigation rates reported are too high. Faecal haemoglobin concentration may offer a valid measure for triaging patients between diagnostic modalities, due to its association with colonic pathology. Objective: To investigate the re-investigation rate and risk classification in complete colon capsule endoscopies in a screening population stratified by faecal haemoglobin concentration. Design: Cross-sectional analyses of a data set derived from the intervention arm of a large randomised controlled trial, CareForColon2015, conducted in the Region of Southern Denmark between August 2020 and December 2022. Methods: Complete colon capsule endoscopy investigations were identified, and the proportions of investigations leading to re-investigation by colonoscopy were calculated, stratified by faecal haemoglobin concentration. Further, the odds of re-investigation were estimated by logistic regression models and the odds of increased risk classification by ordinal regression models. Results: The re-investigation rate was 58.6% in 1413 complete colon capsule endoscopies out of 2030 procedures. There were no significant differences ( p = 0.312) in re-investigation rates between faecal haemoglobin concentration subgroups with 58.2%, 61.1% and 62.7% in the groups of 100–249, 250–499 and >499 ng hb/mL buffer, respectively. The odds of referral for re-investigation did not differ significantly either. The odds of increased risk classification (i.e. higher than level one) was 1.17 (CI 95% 0.92; 1.49, p = 0.211) for concentrations between 250 and 499 ng hb/mL buffer, and 1.40 (CI 95% 1.12; 1.77, p = 0.003) for concentrations above 499 ng hb/mL buffer, compared to 100–249 ng hb/mL buffer. Conclusion: Faecal haemoglobin concentration did not prove to be a stand-alone selection parameter for diagnostic modality in a faecal immunochemical test-positive colorectal cancer screening population, although it was significantly associated with an increased risk classification.

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

Background/Objectives: Colonoscopy is the standard examination for many symptomatic patients referred for lower-gastrointestinal investigation, but it is resource-intensive and may be a burdensome experience. Colon capsule endoscopy (CCE) offers a minimally invasive, sedation-free first-line examination, although clinically important findings, inadequate cleansing or incomplete transit can generate downstream colonoscopy. DanCap aims to compare the costs and clinical consequences of a CCE-first pathway with routine conventional colonoscopy (CC). Methods: DanCap is a single-centre, cluster-allocated crossover trial at Odense University Hospital, Denmark. General practice clinics follow CCE or CC according to the parity of their pre-existing provider number, with pathways crossing after 200 consecutive CCE participants; no trial-generated random allocation sequence is used. Eight hundred symptomatic adults aged >18 years referred for expedited lower-gastrointestinal investigation are planned. CCE participants with suspected cancer, any polyp ≥6 mm, inadequate cleansing or an incomplete examination are referred for colonoscopy. The primary outcome is pathway cost. Registered secondary outcomes and prespecified process measures include polyp and colorectalcancer detection, examination quality, reinvestigation and patient-reported consequences. FIT and microbiome are registered secondary outcomes; participation in the substudy is optional and the analyses are exploratory within the CCEpathway. Primary analyses will follow the assigned pathway and account for GP clinic clustering, period and allocation sequence. Expected Results: The trial will quantify the resource use and clinical consequences of implementing CCE in routine symptomatic practice. Conclusions: DanCap is intended to inform decisions about CCE pathway implementation rather than to establish unbiased whole-cohort test sensitivity or specificity. Trial registration: ClinicalTrials.gov NCT06475560; first submitted 20 June 2024 and first posted 26 June 2024. Recruitment began on 27 November 2024; the registry listed the study as recruiting when last updated on 19 March 2026.

The purpose of this position statement is to propose expected performance values for artificial intelligence (AI) applications in colon capsule endoscopy (CCE), with emphasis on detection, characterization, localization, reporting, and downstream management of colonic neoplasia. The task force was created within the Artificial Intelligence in Capsule Endoscopy (AICE) consortium project work and drew on members of the international CApsule endoscopy REsearch (iCARE) group for development, review, consensus voting, and final approval. These values are intended as consensus-based benchmarks for research, validation, and future clinical translation, while explicitly acknowledging the limited availability of robust CCE-specific clinical evidence. The task force included CCE experts, technical experts, patient representatives, and an ethicist, and defined expected values using existing endoscopy quality frameworks, available capsule endoscopy literature, relevant proxy evidence from colonoscopy, and structured Delphi consensus. A supermajority agreement of more than 80% across up to three Delphi voting rounds was required for consensus. The agreed statements address candidate selection, assessment of mucosal visualization and procedure completeness, landmark and segment recognition, polyp matching, lesion size estimation, reading-time reduction, detection of colorectal neoplasia, false-positive burden, risk stratification for subsequent procedures, prediction of advanced pathology, urgency categorization, and automated report generation. The proposed thresholds should not be interpreted as definitive requirements for immediate clinical adoption. Instead, they identify minimum expected value and aspirational value that future systems should be tested against in prospective, externally validated, full-video CCE studies.

BACKGROUND:Total mesorectal excision (TME) is the standard treatment for most early-stage and intermediate-stage rectal cancer but can cause substantial perioperative morbidity, functional impairment, and reduced quality of life. We assessed whether long-course chemoradiotherapy (LCCRT) or short-course radiotherapy (SCRT) could increase organ preservation and reduce surgery, toxicity, and quality-of-life harms without compromising oncological outcomes. METHODS:STAR-TREC is an international, multicentre, open-label, parallel-group, randomised, phase 2/3 trial in five European countries. Eligible patients were aged 16 years or older in the UK or aged 18 years or older elsewhere, had an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, and rectal adenocarcinoma (≤40 mm staged as mrT1-T3bN0). In phase 2, participants were randomly assigned (1:1:1) to LCCRT-based organ preservation (LCCRT-OP; 50 Gy in 25 fractions plus oral capecitabine 825 mg/m2 twice daily), SCRT-based organ preservation (SCRT-OP; 25 Gy in five fractions), or primary TME. Phase 2 assessed feasibility, with recruitment at months 12 and 24 as the primary endpoint and feasibility thresholds of four or more and six or more randomisations per month, respectively. Phase 3 adopted a partially randomised patient-preference design, allowing participants to choose either organ preservation or TME. Participants that chose organ preservation were randomly assigned (1:1) to receive LCCRT-OP or SCRT-OP using centralised, computer-generated assignment, with stratification by country and MRI T category (≤T3a vs T3b) using minimisation. The phase 3 primary endpoint was organ-preservation 30 months after treatment initiation, defined as absence of TME, stoma, or local recurrence, which was assessed in the modified intention-to-treat population, which included participants in phase 2 and phase 3. After a planned interim analysis of unmasked phase 2 data, the trial steering committee and independent data monitoring committee recommended reporting a 12-month, modified intention-to-treat analysis of implementation outcomes for participants recruited before Aug 8, 2023. This study is registered with ISRCTN (14240288) and is closed. FINDINGS:Between June 14, 2017, and April 8, 2024, 503 participants were enrolled at 37 sites. Phase 2 enrolled 120 participants, with recruitment rates of three and six participants per month at months 12 and 24, respectively. Overall, 12-month TME-free survival was 60% (47 of 78 participants). After phase 3 recruitment ended, interim analysis of unmasked phase 2 data showed an early TME-free survival benefit with LCCRT versus SCRT (12-month median TME-free survival not reached [95% CI not reached-not reached] vs 7·6 months [95% CI 6·4-not reached]; hazard ratio [HR] 3·7 [95% CI 1·7-8·0]; posterior probability of superiority >99·5%). The trial steering committee and independent data monitoring committee therefore recommended expanded analysis of 426 participants recruited before Aug 8, 2023: 120 from phase 2 and 306 from phase 3. 17 participants withdrew before treatment, leaving 409 in the modified intention-to-treat population: 163 allocated to LCCRT, 168 to SCRT, and 78 to primary TME. 116 (28%) participants were female and 293 (72%) were male. Among participants who opted for organ preservation, 12-month TME-free survival was 78·5% (95% CI 72·4-85·1) with LCCRT and 60·6% (53·6-68·4) with SCRT (HR 1·90 [95% CI 1·29-2·81]). The most common grade 3-4 serious adverse events were gastrointestinal disorders (four [2%] with LCCRT vs six [4%] with SCRT vs six [8%] with TME) and procedural complications (three [2%] with LCCRT vs five [3%] with SCRT vs five [6%] with TME). One participant allocated to primary TME died after an anastomotic leak. INTERPRETATION:These early results support a response-adapted organ-preservation approach, with LCCRT appearing more effective than SCRT at 12 months. Organ-preservation might also reduce treatment-related toxicity compared with primary TME. Longer follow-up is needed for the prespecified 30-month endpoint and definitive functional and oncological outcomes. FUNDING:Cancer Research UK, Stand Up to Cancer, Dutch Cancer Society, Danish Cancer Society, Kom Op Tegen Kanker, Cancerfonden, ALF Region Stockholm, RCC Region Stockholm.

Background and study aims:In recent years, several large national studies have been published reporting on outcomes of colon capsule endoscopy (CCE) in both symptomatic and screening settings, significantly contributing to the expanding body of real-world evidence on CCE. Therefore, we have compiled these studies to provide an overview of key developments, current challenges, and valuable insights they offer into the evolving role of CCE. Patients and methods:We examined three multicenter studies reporting on outcomes of CCE including the NHS England study with 4,878 symptomatic patients; the ScotCap pilot with 316 symptomatic patients; the ScotCap registry with 1,087 predominantly symptomatic patients (95.9%); and the CareForColon 2015 study with 1,790 patients in a screening setting. For the ScotCap pilot study, only symptomatic patients were included. Results:ScotCap pilot reported the highest rate of adequate bowel preparation (79.4%) without using prucalopride. CareForColon2015 achieved a significantly higher rate of complete tests (91.7%) compared with other studies. NHS England reported a notably lower rate of follow-up endoscopy (46.7%), indicating effective patient selection. ScotCap pilot reported one case of missed colorectal cancer. Sensitivity of CCE for detecting polyps ≥ 10 mm ranged from 93.8% to 97.0% on a per-patient basis and from 75.0% to 95.8% on a per-polyp basis in the NHS England and ScotCap trials. Conclusions:These national CCE programs reveal the complexity of large-scale implementation, driven by variations in definitions and protocols. Harmonized quality metrics and shared definitions of success are essential. Efforts should focus on reducing downstream procedures and fostering cross-system learning.

Introduction A large bowel cancer chemoprevention potential has been demonstrated by the consumption of carrots, which represent the major dietary source of polyacetylenes. Their interaction with cancer cells and enzyme systems of animals and humans has been systematically investigated over the last 15 years and has now been characterised as anti-inflammatory compounds with antineoplastic effect. Our objective is to investigate whether selected carrot species with a high content of the polyacetylenes falcarinol (FaOH) and falcarindiol (FaDOH) prevent neoplastic transformation and growth in humans, without side effects.Methods and analysis We will conduct a multicentre prospective binational (Denmark and Sweden) randomised controlled trial, with the aim to test the clinical effects of adjuvant treatment with carrot juice in patients who had an excision of high-risk colon adenomas. Patients from six centres will be randomised to receive either anti-inflammatory juice made of carrots high in FaOH and FaDOH or placebo. We will compare the proportion of participants with recurrent adenoma and mean size of them, found in the 1-year follow-up colonoscopy between the two randomised groups.Ethics and dissemination Informed written consent will be obtained from all participants before randomisation. The study was approved by the regional ethics committee in Denmark (ref. S-20230072) and Sweden (ref. 2024-04732-01). After completion of the trial, we plan to publish two articles in high-impact journals: one article on primary and secondary outcomes, respectively.Trial registration number NCT06335420.

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.

BACKGROUND:Bowel symptoms are common in general practice and though most often benign they can also indicate colorectal cancer where a colonoscopy often is required to rule out malignant disease. Colon capsule endoscopy (CCE) is suggested as a more patient-friendly alternative to colonoscopy but its application in symptomatic patients in general practice needs further investigation. MATERIALS AND METHODS:We present a feasibility study of integrating initial triage for CCE into general practice. The technical success of CCE, patient acceptance, and the experiences of general practitioners (GPs) are assessed through qualitative interviews with participating GPs. RESULTS:We were able to recruit some general practices from the area of interest, but inclusion of patients was low. The participating GPs welcomed the concept of CCE as a more patient-friendly procedure and most patients invited by the GP accepted inclusion. Difficulties remembering the project in the diverse everyday of general practice, GP shortage and general time restraints were reported as barriers for patient recruitment by the GPs. CONCLUSION:Before conducting large-scale implementation studies of CCE, our investigation highlighted critical barriers that need addressing: (1) Time Constraints and GP Shortages: The design of task divisions between sectors should carefully consider time limitations and the scarcity of GPs. (2) Low reinvestigation rates: Minimizing reinvestigation rates is crucial to reduce strain on both patients and healthcare systems.

Background Colonoscopy is among the standard tests for colorectal cancer (CRC) screening. However, uptake varies, and alternatives such as colon capsule endoscopy (CCE) are available. The uptake and detection rate of clinically significant neoplasia with CCE, compared with colonoscopy, remain unclear in this setting. Objective The primary objective of this study was to compare the detection rates of advanced neoplasia between CCE and colonoscopy, using a pathway in which the study group could choose between the two procedures, while the control group was offered only colonoscopy. Design A randomised, intention-to-treat trial was conducted among Danish CRC screening participants who tested positive with a faecal immunochemical test (FIT). The trial compared the detection rate of advanced neoplasia (primary outcome) and the uptake rate of both approaches between the two arms. Results A total of 473 684 invitations were sent to 396 676 individuals, with 62.6% returning the test. Among them, 11 075 tests were positive (4.5%), with no significant differences between the two study groups. Among FIT-positive cases, the uptake for colonoscopy was 91.1% in the control arm and 91.7% in the study arm, where participants had a choice of methods. In the study arm, 45.8% preferred CCE, 11.4% preferred colonoscopy and 42.8% had no preference and underwent colonoscopy. Ultimately, 69.9% of patients who initially opted for CCE were later referred for colonoscopy. The rate of advanced neoplasia detection was similar between the groups: 0.67% in the study arm versus 0.64% in the control arm. Conclusion Offering CCE as an alternative to colonoscopy did not significantly alter the detection rate of advanced neoplasia, nor did it increase uptake in a screening programme with high adherence to colonoscopy following a positive FIT test. Instead, it led to a very high rate of secondary colonoscopies. Therefore, CCE cannot be recommended in this setting. Trial registration number NCT04049357 (ClinicalTrials.gov)

OBJECTIVES:Significant sociodemographic inequalities in participation in colorectal cancer (CRC) screening programmes across the globe are evident. We aimed to investigate the effect of introducing colon capsule endoscopy (CCE) as a filter test in faecal immunochemical test (FIT)-based CRC screening on overall FIT participation and social inequalities in FIT participation. STUDY DESIGN:We conducted a randomised controlled trial, randomising 368,452 individuals. METHODS:Both groups received an invitation to submit a FIT sample, which elicited a follow-up investigation if ≥ 20 μg haemoglobin/g faeces was detected. The control group followed the standard screening pathway and was referred for follow-up colonoscopy. The intervention group were free to choose between colonoscopy and colon capsule endoscopy. RESULTS:The overall FIT participation proportion was significantly lower in the intervention group (63.4 %), compared to the control group (64.9 %). All sociodemographic subgroups in the intervention group had lower participation proportions than their control group counterpart, with an average of 1.4 (range 0.3-2.7) percentage points lower participation. The odds of non-participation, divided by sociodemographic characteristics, were not significantly different between interventions and controls for any subgroup, except for those aged 55-59 in which the odds ratios for non-participation was 1.59 (1.54-1.65) in the control group and 1.48 (1.43-1.53) in the intervention group, comparing them to those aged above 70. CONCLUSIONS:Introducing a free choice between colon capsule endoscopy and colonoscopy if FIT positive did not increase FIT participation in CRC screening. Further, it did not affect the pattern of social inequalities in FIT uptake.

Despite recent surge of interest in deploying colon capsule endoscopy (CCE) for early diagnosis of colorectal diseases, there remains a large gap between the current state of CCE in clinical practice, and the state of its counterpart optical colonoscopy (OC). This is due to several factors, such as low quality bowel cleansing, logistical challenges around both delivery and collection of the capsule, and most importantly, the tedious manual assessment of images after retrieval. Our study, built on the "Danish CareForColon2015 trial (cfc2015)" is aimed at closing this gap, by focusing on the full integration of AI in CCE's pathway, where image processing steps linked to the detection, localization and characterisation of important findings are carried out autonomously using various AI algorithms. We developed a family of algorithms based on explainable deep neural networks (DNN) that detect polyps within a sequence of images, feed only those images containing polyps into two parallel independent networks to characterize, and estimate the size of important findings. Our recognition DNN to detect colorectal polyps was trained and validated ([Formula: see text]) and tested ([Formula: see text]) on an unaugmented database of 1751 images containing colorectal polyps and 1672 images of normal mucosa reached an impressive sensitivity of [Formula: see text], a specificity of [Formula: see text], and a negative predictive value (NPV) of [Formula: see text]. The characterisation DNN trained on an unaugmented database of 317 images featuring neoplastic polyps and 162 images of non-neoplastic polyps reached a sensitivity of [Formula: see text] and a specificity of [Formula: see text] in classifying polyps. The size estimation DNN trained on an unaugmented database of 280 images reached an accuracy of [Formula: see text] in correctly segmenting the polyps. By automatically incorporating important information including size, location and pathology of the findings into CCE's pathway, we moved a step closer towards the full integration of explainable AI (XAI) in CCE's routine clinical practice. This translates into a fewer number of unnecessary investigations and resection of diminutive, insignificant colorectal polyps.

OBJECTIVE:The risk of incomplete colonoscopy is associated with demographic factors and general comorbidity. However, focus on specific comorbidities is limited. This study aimed to investigate the association between selected comorbidities and incomplete colonoscopy in colorectal cancer (CRC) screening. METHODS:This register-based study included 71,973 Danish screening participants, undergoing colonoscopy after positive fecal immunochemical test. The selected comorbidities were divided into hematological disease, endocrine disease (nondiabetes), endocrine disease (diabetes related), upper gastrointestinal (GI) disease, lower GI disease, other diseases of digestive system, hepatobiliary and pancreatic (HBP) disease, CRC, intraabdominal cancer (except CRC), and mental disease. Outcomes were incomplete colonoscopy due to poor bowel preparation and other reasons. Multivariate logistic regression models were applied. RESULTS:Of 5,428 (7.5%) incomplete colonoscopies, 2,625 (3.6%) were due to poor bowel preparation and 2,803 (3.9%) due to other reasons. Individuals with specific comorbidities were compared to those without, exhibiting varying odds ratios (OR) for incomplete colonoscopy. For poor bowel preparation, ORs were 1.20 (95%CI: 1.04;1.39), 1.43 (95%CI: 1.30;1.56), 1.86 (95%CI: 1.66;2.09), 1.27 (95%CI: 1.12;1.43), and 1.64 (95%CI: 1.47;1.83) for hematological, endocrine (nondiabetes), endocrine (diabetes related), HBP, and mental disease, respectively, and 1.29 (95%CI: 1.09;1.52) for intraabdominal cancer (except CRC). Incomplete colonoscopies due to other reasons showed ORs of 1.24 (95%CI: 1.08;1.43), 1.18 (95%CI: 1.03;1.36), 1.19 (95%CI: 1.05;1.35), and 1.30 (95%CI: 1.15;1.47) for hematological, endocrine (diabetes related), HBP, and mental disease, respectively, and 1.35 (95%CI: 1.15;1.60) for intra-abdominal cancer (except CRC). CONCLUSION:Participants with specific comorbidities had significantly higher probability of having an incomplete colonoscopy, suggesting that certain comorbidities could be used prospectively as a predictive factor.