Abstract
BackgroundAccess to community rectoscopy might help to ease the burden on hospital services and reduce costs for the NHS. To assess this, a prospective multicentre observational phase I feasibility study of a novel digital rectoscope and telestration software for the triage of lower gastrointestinal (GI) symptoms was undertaken.AimTo determine if digital rectoscopy is feasible, acceptable, and clinically safe.Design & settingEvaluation of clinician case reports and patient questionnaires from patients recruited from five primary care centres.MethodAdults meeting 2-week wait (2WW) criteria for suspected lower GI cancer, suspected new diagnosis, or flare-up of inflammatory bowel disease (IBD) were enrolled. Examinations were performed by primary care practitioners using the LumenEye rectoscope. The CHiP platform allowed immediate remote review by secondary care. A prospective analysis was performed of patient and clinician experiences, diagnostic accuracy, and cost.ResultsA total of 114 patients were recruited and 110 underwent the procedure (46 [42%] females and 64 [58%] males). No serious adverse events were reported. Eighty-two (74.5%) patients reported that examination was more comfortable than expected, while 104 (94.5%) felt the intervention was most convenient if delivered in the community. Clinicians were confident of their assessment in 100 (87.7%) examinations. Forty-eight (42.1%) patients subsequently underwent colonoscopy, flexible sigmoidoscopy, or computed tomography virtual colonoscopy (CTVC). The overall sensitivity and specificity of LumenEye in identifying rectal pathology was 90.0% and 88.9%. It was 100% and 100% for cancer, and 83.3% and 97.8% for polyps. Following LumenEye examination, 19 (17.3%) patients were discharged, with projected savings of 11 305 GBP.ConclusionDigital rectoscopy in primary care is safe, acceptable, and can reduce referrals. A phase III randomised controlled trial is indicated to define its utility in reducing the burden on hospital diagnostic services.
Publisher
Royal College of General Practitioners
Reference21 articles.
1. Rectal bleeding in general practice: new guidance on commissioning
2. The early detection of colorectal cancer in primary care;Jones;Br J Gen Pract,1999
3. National Cancer Registration and Analysis Service Urgent suspected cancer referrals: referral, conversion and detection rates. accessed. http://www.ncin.org.uk/cancer_type_and_topic_specific_work/topic_specific_work/tww_conversion_and_detection. 4 Aug 2022.
4. Office for National Statistics (2019) Cancer registration statistics, England: 2017. accessed. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/cancerregistrationstatisticsengland/2017. 4 Aug 2022.
5. Coward A Moon K McDonnell P (2021) Waiting times for suspected and diagnosed cancer patients: 2020–21 annual report. accessed. https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2021/07/Cancer-Waiting-Times-Annual-Report-202021-Final.pdf. 4 Aug 2022.