Piloting Colon Capsule Endoscopy (CCE) in Wales

Introduction:

Colon Capsule Endoscopy (CCE), is a painless procedure, where a patient swallows a pill containing two tiny cameras to examine the large bowel (colon). There is some evidence that suggests it can be used as a diagnostic tool, with high sensitivity and specificity within selected groups of patients, and can help to reduce the need for optical colonoscopy. The British Society of Gastroenterology (BSG) reports that evidence to date, indicates that procedure-related distress (discomfort and embarrassment) is less with CCE than colonoscopy and has a similar diagnostic sensitivity to colonoscopy in clinical trials. The BSG calls for studies in routine clinical practice–which is what will be achieved through this project.

Context:

Colonoscopy is used to diagnose lower gastrointestinal (LGI) conditions such as colorectal cancer (CRC), inflammatory bowel disease, pre-cancerous conditions such as bowel polyps. However, it is an invasive procedure with significant demand on service and operator resources and time.

Prior to the onset of the COVID-19 pandemic, the numbers of patients referred for endoscopy exceeded capacity across NHS Wales considerably, particularly in relation to colonoscopy. This situation has worsened and patients in Wales currently face long waiting times for diagnostic procedures such as Colonoscopy, leading to poorer outcomes.

CCE could contribute to solutions to colonoscopy capacity issues within the lower gastro-intestinal cancer pathway, by providing another diagnostic option for clinicians to offer patients waiting for a colonoscopy. NHS Scotland and some NHS Trusts in England have recently piloted CCE in certain services. However, to date the benefits and potential positive outcomes of using CCE to our citizens, within a Welsh context, remain unproven.

Aim:

The broad aim of the project is to instigate the implementation of CCE in 4 participating health boards (Betsi Cadwaladr University Health Board, Cwm Taf Morgannwg University Health Board, Swansea Bay University Health Board, Cardiff & Vale University Health Board). This will be done with a robust governance and evaluation framework structure in place to assess its appropriateness as a solution to capacity issues, particularly for colonoscopy, and safety netting requirements within the lower gastro-intestinal pathway.

The approach:

• All health boards invited, 4 responded positively – CTMUHB, CAVUHB, BCUHB and SBUHB
• Arrange software, equipment and consumables for each health board
• Training for consultants and specialist nurses
• National working group engagement
• Established national approach and IG processes
• Patient and staff surveys, evaluation by CEDAR

Outcomes /Benefits:

• Significant bowel disease detected in 57% of patients
• Demonstrable potential for reduced demand on colonoscopy services and reduced workforce pressures
• IG and quality assured CCE services established in 4 health boards
• Reduced need/ avoidance of invasive colonoscopy procedure
• Very positive patient responses
• Staff felt CCE had a role in reducing waiting lists and should be extended across Wales

What Next?

• Joint application with England and Scotland in NIHR
• Initiate development and adoption of technology
• Develop multi professional pool of experts using remote reader across boundaries
• Embed as national service in Wales based on evidence gathered

View project posters and slides from the PCIP National Showcase Event