Title: Factors predicting conversion from Colon Capsule Endoscopy to Conventional Optical
Endoscopy - findings from the CESCAIL Study
Version: 4 Date: 18 Feb 2025
Reviewer:  Konosuke Nakaji
Reviewer's report:
Colon capsule endoscopy (CCE) is considered a non-invasive, safe, and environmentally
friendly (low CO2 emission) screening method for colorectal cancer compared to other
modalities. However, contrary to initial expectations, its global adoption has not progressed
as anticipated. This study examines factors leading to conversion to conventional colonoscopy
(CCC) due to incomplete CCE, using data from an existing study (CESCAIL study: comparison
of polyp detection rates in CCE between humans and AI). Although it has limitations as a
retrospective analysis of existing data, this research is considered highly valuable for improving
the acceptability and cost-effectiveness of CCE, which has drawbacks of laxative-related
discomfort and high cost, and for reducing CCC conversions to promote CCE adoption.
The study found that non-smokers with low f-Hb levels are less likely to require conversion to
conventional endoscopy (CCC). Furthermore, it showed that being a male, non-diabetic, non-
smoker, and non-alcoholic consumer reduces the risk of incomplete capsule excretion. Overall,
there are no significant issues, but there are some points of concern:
1. For readers unfamiliar with CCE, please describe the features of second-generation CCE (e.g.,
AFR function) and its accuracy (sensitivity and specificity compared to CS as the gold standard).
Was there a standardized laxative regimen? How was the image interpretation conducted
(including human and AI methods)? What is the price of CCE compared to conventional CS?
2. Does "smoker" include past smoking? What is the quantity of alcohol consumed by alcohol
consumers? What are the definitions of hyperlipidemia and psychological state scales? Should
the education level of subjects have been considered? Is the definition of IBD appropriate for
UC and CD? Does diabetes include only Type 2?
3. What specific size (in millimeters) is considered "large" for polyps? Was the Paris
classification used for polyp morphology?
4. The text states, "Inappropriate CCE is assumed to have been converted mainly to conventional
CS rather than repeating CCE or proceeding to CT colonography. This is mainly due to concerns
about inadequate bowel preparation." Did these patients have prior experience with conventional
endoscopy before undergoing CCE?
Title: Factors predicting conversion from Colon Capsule Endoscopy to Conventional Optical
Endoscopy - findings from the CESCAIL Study
Version: 4 Date: 18 Feb 2025
Reviewer:  Konosuke Nakaji
Reviewer's report:
Colon capsule endoscopy (CCE) is considered a non-invasive, safe, and environmentally
friendly (low CO2 emission) screening method for colorectal cancer compared to other
modalities. However, contrary to initial expectations, its global adoption has not progressed
as anticipated. This study examines factors leading to conversion to conventional colonoscopy
(CCC) due to incomplete CCE, using data from an existing study (CESCAIL study: comparison
of polyp detection rates in CCE between humans and AI). Although it has limitations as a
retrospective analysis of existing data, this research is considered highly valuable for improving
the acceptability and cost-effectiveness of CCE, which has drawbacks of laxative-related
discomfort and high cost, and for reducing CCC conversions to promote CCE adoption.
The study found that non-smokers with low f-Hb levels are less likely to require conversion to
conventional endoscopy (CCC). Furthermore, it showed that being a male, non-diabetic, non-
smoker, and non-alcoholic consumer reduces the risk of incomplete capsule excretion. Overall,
there are no significant issues, but there are some points of concern:
1. For readers unfamiliar with CCE, please describe the features of second-generation CCE (e.g.,
AFR function) and its accuracy (sensitivity and specificity compared to CS as the gold standard).
Was there a standardized laxative regimen? How was the image interpretation conducted
(including human and AI methods)? What is the price of CCE compared to conventional CS?
2. Does "smoker" include past smoking? What is the quantity of alcohol consumed by alcohol
consumers? What are the definitions of hyperlipidemia and psychological state scales? Should
the education level of subjects have been considered? Is the definition of IBD appropriate for
UC and CD? Does diabetes include only Type 2?
3. What specific size (in millimeters) is considered "large" for polyps? Was the Paris
classification used for polyp morphology?
4. The text states, "Inappropriate CCE is assumed to have been converted mainly to conventional
CS rather than repeating CCE or proceeding to CT colonography. This is mainly due to concerns
about inadequate bowel preparation." Did these patients have prior experience with conventional
endoscopy before undergoing CCE?
Please review this paper.
user
Title: Factors predicting conversion from Colon Capsule Endoscopy to Conventional Optical
Endoscopy - findings from the CESCAIL Study
Version: 4 Date: 18 Feb 2025
Reviewer:  Konosuke Nakaji
Reviewer's report:
Colon capsule endoscopy (CCE) is considered a non-invasive, safe, and environmentally
friendly (low CO2 emission) screening method for colorectal cancer compared to other
modalities. However, contrary to initial expectations, its global adoption has not progressed
as anticipated. This study examines factors leading to conversion to conventional colonoscopy
(CCC) due to incomplete CCE, using data from an existing study (CESCAIL study: comparison
of polyp detection rates in CCE between humans and AI). Although it has limitations as a
retrospective analysis of existing data, this research is considered highly valuable for improving
the acceptability and cost-effectiveness of CCE, which has drawbacks of laxative-related
discomfort and high cost, and for reducing CCC conversions to promote CCE adoption.
The study found that non-smokers with low f-Hb levels are less likely to require conversion to
conventional endoscopy (CCC). Furthermore, it showed that being a male, non-diabetic, non-
smoker, and non-alcoholic consumer reduces the risk of incomplete capsule excretion. Overall,
there are no significant issues, but there are some points of concern:
1. For readers unfamiliar with CCE, please describe the features of second-generation CCE (e.g.,
AFR function) and its accuracy (sensitivity and specificity compared to CS as the gold standard).
Was there a standardized laxative regimen? How was the image interpretation conducted
(including human and AI methods)? What is the price of CCE compared to conventional CS?
2. Does "smoker" include past smoking? What is the quantity of alcohol consumed by alcohol
consumers? What are the definitions of hyperlipidemia and psychological state scales? Should
the education level of subjects have been considered? Is the definition of IBD appropriate for
UC and CD? Does diabetes include only Type 2?
3. What specific size (in millimeters) is considered "large" for polyps? Was the Paris
classification used for polyp morphology?
4. The text states, "Inappropriate CCE is assumed to have been converted mainly to conventional
CS rather than repeating CCE or proceeding to CT colonography. This is mainly due to concerns
about inadequate bowel preparation." Did these patients have prior experience with conventional
endoscopy before undergoing CCE?
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