EVALUATION OF THE COLON CAPSULE ENDOSCOPY SERVICE AT UCLH IN 2021

Introduction

Colorectal cancer (CRC) is the fourth most common type of cancer diagnosed in the UK every year and the second leading cause of cancer deaths. Despite this, the CRC screening programme still has a low uptake by the public. Colon capsule endoscopy (CCE) offers an alternative to relieve pressures on endoscopy services, and to improve uptake by those patients reluctant to undergo a colonoscopy.

Methods

Data on all CCE procedures at UCLH were collected prospectively. Demographics, completion, procedure specifics and complication rates were recorded. Patients were asked to complete satisfaction questionnaires relating to the process (experience of the process, support from staff, expectations, tolerance of procedure, satisfaction, and preference for future investigations).

Results

From December 2020 to December 2021, 77 CCEs were performed at UCLH. The mean age of patients was 43 (range 19-77) with a 1:1 male: female ratio. Bowel preparation included Moviprep, Gastrografin and Phospho-soda boosters, and Bisacodyl suppository according to manufacturer’s instructions. The excretion rate was 90% (n=69). Another 12 patients had inadequate bowel cleansing, making the total rate of successful procedures 57 (74%). Pathological findings were polyps (17;24% of patients), diverticular disease (17;24%), inflammation (16;22%), angiodysplasias (9;12%) and one colorectal cancer (1.4%). Importantly, 54 patients (70%) did not need to have a further endoscopic investigation (CCE conclusive for diagnosis). There was no association between CCE failure and gender, age, indication or length of study. Interestingly, 83% of patients referred from a gastroenterology clinic were successful versus only 66% if referred from elsewhere (p=0.068), suggesting careful patient selection or patients’ engagement as potential contributing factors to success. There were no significant complications recorded. 27 patients (35%) returned completed questionnaires. On a procedure satisfaction scale of 1-10, 22 (81%) patients scored their CCE as ≥8. 76% of patients would prefer a colon capsule in the future over a colonoscopy or a CT colonography.

Conclusions

CCE has an important role to play in improving endoscopic capacity and reducing colonoscopy waiting times. In our CCE cohort, 70% of colonoscopies were avoided due to conclusive results. There is potential to improve success rates, and the selection of appropriate patients as well as better explanation and patient preparation could play an important role. Our results found that 76% of patients would prefer it over other colonic investigations, showing that it could become a preferred CRC screening tool.