Colon Capsule Endoscopy (CCE) Versus Computed Tomographic Colonography (CTC) in the Identification of Colonic Polyps in a Screening Population. (TOPAZ)
Colorectal Cancer Screening
About this trial
This is an interventional diagnostic trial for Colorectal Cancer Screening focused on measuring Polyps; Capsule endoscopy; CT Colonography; Colonoscopy; Average risk patients for colorectal cancer screening
Eligibility Criteria
Inclusion Criteria:
- Subject is between 50 and 75 years of age (for African Americans only, subject is between 45-75 years of age).
- Subject is classified as average risk per the American Gastroenterological Association Guidelines on Colorectal Cancer Screening: Individuals without a personal or family history of CRC or adenomas, inflammatory bowel disease, or high-risk genetic syndromes.
- Subject is willing and able to participate in the study procedures and to understand and sign the informed consent.
Exclusion Criteria:
- Subject with history of colorectal cancer or adenoma (including those identified by computed tomography [CT], optical colonoscopy [OC[, sigmoidoscopy, etc.).
- Subject with history of negative colonoscopy within 10 years, as these subjects would be defined as not requiring screening in this timeframe. For subjects with alternative screening methods, refer to applicable guidelines.
- Subject with currently suspected or diagnosed with hematochezia, melena, iron deficiency with or without anemia, or any other rectal bleeding, including positive fecal occult blood test of any variety.
- Subject with any current condition believed to have an increased risk of capsule retention such as suspected or known bowel obstruction, stricture, or fistula.
- Subject with current dysphagia or any swallowing disorder.
- Subject with current serious medical conditions that would increase the risk associated with CCE, CTC, or colonoscopy that are so severe that screening would have no benefit.
- Subject with a cardiac pacemaker or other implanted electromedical device.
- Subject expected to undergo MRI examination within 7 days after ingestion of the capsule.
- Subject with clinical evidence of renal disease, including clinically significant laboratory abnormalities of renal function within the past 6 months, or at any time in the past if not tested within the last 6 months, defined as creatinine, blood urea nitrogen (BUN), and/or glomerular filtration rate (GFR) outside of the local laboratory reference range.
- Subject with a diagnosis of gastroparesis or small bowel or large bowel dysmotility.
- Subject with allergies or known contraindication to the medications or preparation agents used in the procedure as described in the relevant instructions for use.
- Subject has an estimated life expectancy of less than 6 months.
- Subject is considered to be part of a vulnerable population (e.g. prisoners or those without sufficient mental capacity).
- Subject is pregnant, suspected pregnant, or is actively breast-feeding. Females of child-bearing potential will be required to provide either a urine pregnancy test or serum pregnancy test as part of the participant's standard of care regardless of their participation in the study (except for subjects who are surgically sterile or are post-menopausal for at least two years).
- Subject has participated in an investigational drug or device research study within 30 days of enrollment that may interfere with the subject's safety or ability to participate in this study.
Sites / Locations
- University of South Alabama
- Borland-Groover Clinic
- Loyola University Medical Center
- Indiana University Hospital
- Indianapolis Gastroenterology and Hepatology
- Baystate Hospital
- Mayo Clinic Rochester
- Clinical Research Professionals
- NYU
- Columbia University
- Asheville Gastroenterology Associates
- Thomas Jefferson University
- Virginia Gastroenterology institute
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
COLON Capsule endoscopy
Computed Tomographic Colonography
Subjects will be instructed to follow a detailed dietary and colon preparation regimen prior to and during the CCE procedure day. With the exception of Gastrografin, all colon preparation products will be standard colon cleansing products approved by the FDA. Between 45 and 75 minutes after the final Polyethylene Glycol (PEG) ingestion, the subject will swallow the PillCam COLON Capsule with a cup of water. If necessary, capsule position will be monitored to ensure adequate booster administration. Subjects will keep a timed diary of key preparation steps and bowel activity, including capsule excretion. Subjects will be allowed to leave the unit 10 hours after capsule ingestion if the capsule is not yet excreted. Subjects leaving before excretion will be instructed to disconnect the recorder at excretion or 12 hours after capsule ingestion (whichever comes first).
Subjects will be instructed to follow a detailed dietary and colon preparation regimen prior to and during the Computed Tomographic Colonography (CTC) procedure day. The CTC procedure and study interpretation will be conducted in accordance with the ACR-SAR-SCBT-MR Practice Parameter for the Performance of CT Colonography in Adults. Colon insufflation will be performed with the subject in the lateral decubitus or supine position.With the subject in the supine position, a CT scout image will be taken to confirm adequate colon distention. If adequate bowel distention is not achieved, additional air will be insufflated into the colon. After scanning the subject in the supine position, the subject will be placed in the prone position, and additional CO2 will be administered. Subsequently, CT will be performed with the subject in the prone position. If a prone position is not possible for the subject, a left lateral decubitus position is preferred for optimal gas and fluid redistribution.