Practice Point: Capsule colonoscopy for screening is not quite ready for prime time, yet.
EBM Pearl: Evidence-informed care has three pillars: clinical expertise, application of the best available research, and patient values and preferences.
“Neither be the first to use a new drug, or the last to discard an old one.”
In other words, look before you leap onto the latest bandwagon. The following paper is about a new device developed a few years ago, but it illustrates how any advance in medicine may at first appear to be a huge step forward but we can’t count on it until we double check.
GI doctors were told a few years ago that they would soon be performing far fewer screening colonoscopies, as patients could now swallow a smart pill and get the same results. A Danish study published in Gut in April evaluated 1,790 patients with a positive fecal immunochemical (FIT) test who were randomized to either be given an option for colon capsule endoscopy (with follow-up colonoscopy if positive) or to go directly to colonoscopy. It was hypothesized that many patients would avoid colonoscopy. However, most of the patients who elected the colon capsule endoscopy required a follow-up colonoscopy anyways, and overall, there was no advantage in case finding or overall adherence with the colon capsule option, at least for this population. Given that capsule endoscopy requires a more stringent clean-out preparation than standard colonoscopy, would you want to spend the time and/or money for a high-tech option when you are probably going to end up doing things the “old” way anyways?
In this case, a brand new and promising gadget was initially widely predicted to impact clinical practice. However, as this randomized trial illustrates, the real-life truth may sometimes give us a very different outcome. Ironically, AI-interpreted capsule colonoscopy is currently being investigated and may generate different results than this outcome. When studies are published on that technological advance, we’ll talk about it then! Meanwhile, when we help our patients make informed choices about their diagnostic and treatment options, we shouldn’t automatically assume that newer is better until there is outcome-based evidence to double check.
We hope you enjoyed our three-part miniseries! Remember: stick to the basics of your craft and trust your clinical judgment, keep up with literature but don’t jump on every new bandwagon, and always ask your patients what matters most to them. Lest you think we are anti-tech, we most vehemently are not. If one aphorism sums up our beliefs regarding promising new medicines/procedures/technology, it’s the motto of the great state of Missouri: Show Me.
DynaMed EBM Focus Editorial Team
This EBM Focus was written by Dan Randall, MD, MPH, FACP, Senior Deputy Editor at DynaMed. Edited by Alan Ehrlich, MD, FAAFP, Executive Editor at DynaMed and Associate Professor in Family Medicine at the University of Massachusetts Medical School; Katharine DeGeorge, MD, MS, Senior Deputy Editor at DynaMed and Associate Professor of Family Medicine at the University of Virginia; Gayle Sulik, PhD, Senior Medical Editor and Team Lead for Palliative Care at DynaMed; McKenzie Ferguson, PharmD, BCPS, Senior Clinical Writer at DynaMed; Rich Lamkin, MPH, MPAS, PA-C, Clinical Writer at DynaMed; Matthew Lavoie, BA, Senior Medical Copyeditor at DynaMed; Hannah Ekeh, MA, Senior Associate Editor II at DynaMed; and Jennifer Wallace, BA, Senior Associate Editor at DynaMed.