**Author details**

of 41 patients who underwent colon capsule endoscopy as an out of clinic study. Successful‐ ly completed colon capsule endoscopy examinations in this out-of-clinic trial, including cap‐ sule excretion rates and colon cleansing levels were similar to those of the two published inclinic trials. This study concluded that second generation colon capsule endoscopy may be

To summarize the above: offering colonoscopy only in colon cancer screening programs re‐ duces adherence. Loss of work and the need to have a person accompany the subject to be screened by colonoscopy are significant reasons for decreased adherence to undergo colono‐ scopy screening. Reduced adherence compromises the effectiveness of colonoscopy even if colonoscopy admittedly is the gold standard. Colon capsule endoscopy can offer itself as a non invasive test to identify patients with colonic polyps. In the future colon capsule endos‐ copy could be offered as an out of clinic test which potentially could further increase adher‐ ence rates for colon cancer screening programs. Modern technology has set the tone. Invasive diagnostic tests will be replaced with less or non invasive tests. Colon capsule en‐

For colonoscopy to reduce colon cancer rates certain criteria have to be met. Colonoscopy has to be carried out by competent endoscopists (operator dependent). Bowel cleansing has to be optimal. Cecal intubation has to be achieved (complete colonoscopy). Incomplete colo‐ noscopy, ie the failure to intubate the cecum with the colonoscope, in general practice is higher than expected [12]. Complete colonoscopy rates have been reported from 60% to over 90% [13],[14],[15]. If for whatever reason complete colonoscopy cannot be achieved then in‐ gestion of the colon capsule endoscope for visualization of the uninspected part of the colon is feasible. Colon capsule endoscopy in this setting may be especially attractive since it is the right colon which is usually not visualized in incomplete conventional colonoscopy whereas the right colon is routinely visualized by capsule endoscopy. A prospective multicenter Eu‐ ropean study demonstrated that colon capsule endoscopy in case of incomplete colonoscopy (74 cases) or contraindicated colonoscopy (26 cases) yields a high number of relevant diag‐ nostic findings (36 %) including one right sided colonic cancer. Furthermore, the authors re‐ port that during a one year follow up of this study no adenocarcinoma of the colon was missed by the colon capsule[16]. It should be emphasized that this study was performed

Colon capsule endoscopy has come a long way in a very short time. Technological develop‐ ments are so rapid that studies performed in the years 2006 and 2007 with the first genera‐ tion of colon capsules are already outdated. Second generation colon capsule endoscopy has a diagnostic sensitivity of 89% or higher to identify patients with polyps equal to or larger than 5 mm. In addition to this high sensitivity colon capsule endoscopy is non invasive, painless, protects one's privacy, may be offered in the future as an out of clinic (or possibly

offered as an out-of-clinic medically supervised procedure [11].

250 Colonoscopy and Colorectal Cancer Screening - Future Directions

with the inferior (today outdated) first generation colon capsule.

doscopy may fit this paradigm. **b.** Incomplete Colonoscopy.

**7. Conclusion**

Samuel N. Adler1 and Cesare Hassan2

