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Research

A novel digital rectoscope for the triage of lower gastrointestinal symptoms in primary care: a prospective multicentre feasibility study

James Lewis, Alan Askari, Arihant Mehta, Yasmin Razak, Prash Patel, Ravi Misra, Henry Tilney, Tanveer Ahmed, Mooyad Ahmed, Adnan Syeed, John Camilleri-Brennan, Ralph John Nicholls and James Macalister Kinross
BJGP Open 2022; 6 (3): BJGPO.2022.0036. DOI: https://doi.org/10.3399/BJGPO.2022.0036
James Lewis
1 Clinical Research Fellow, Imperial College Healthcare NHS Trust, London, UK
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Alan Askari
2 Clinical Research Fellow, St Mark’s Hospital, London, UK
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Arihant Mehta
3 Medical Student, School of Medicine, King’s College London, London, UK
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Yasmin Razak
4 GP, The Golborne Medical Centre, London, UK
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Prash Patel
5 GP, Magnolia House Practice, Ascot, UK
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Ravi Misra
6 Consultant Gastroenterologist, St Mark’s Hospital, London, UK
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Henry Tilney
7 Consultant Colorectal and Robotic Surgeon, Frimley Park Hospital, London, UK
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Tanveer Ahmed
8 GP, Shifa Surgery, Blackburn, UK
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Mooyad Ahmed
9 Consultant General Surgeon, East Lancashire Hospitals NHS Trust, London, UK
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Adnan Syeed
10 GP, Forth Medical Group, Forth Valley, UK
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John Camilleri-Brennan
11 Consultant General and Colorectal Surgeon, Forth Valley Royal Hospital, Forth Valley, UK
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Ralph John Nicholls
12 Visiting Professor in Colorectal Surgery, Department of Biosurgery and Surgical Technology, Imperial College London, London, UK
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James Macalister Kinross
13 Consultant Colorectal Surgeon, Imperial College Healthcare NHS Trust, London, UK
14 Senior Lecturer in Colorectal Surgery, Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
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  • ORCID record for James Macalister Kinross
  • For correspondence: j.kinross@imperial.ac.uk
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  • Figure 1.
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    Figure 1. The LumenEye system

    A - The LumenEye® device without its disposable plastic sleeve. The disposable plastic sleeve is graduated to 15cm and includes a 3mm working channel to accommodate endoscopic instruments. The handle contains an air insufflator bellows (blue) allowing single handed use.

    B - The LumenEye® dock with the CHiP software. A typical view during a live specialist ‘proctoring’ examination with webcam displays of both the examining clinician and proctor projected over the view from the rectoscope.

    C - The LumenEye® in a typical deployment in a GP practice with remote secondary care review via CHiP.

  • Figure 2.
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    Figure 2. Flow diagram demonstrating the outcome of patients in the trial. Follow-up data are available for 110 of 114 patients. Three patients were unable to tolerate the procedure and one patient was lost to follow-up despite numerous efforts to contact him. CTVC = computed tomography virtual colonoscopy.

Tables

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    Table 1. Demographics and presenting symptoms of participants (N = 110)
    CategoryVariablen%
    SexFemale4641.8
    Male6458.2
    Diagnosis of IBDYes43.6
    No10696.4
    Rectal bleedingYes7265.5
    No3834.5
    Change in bowel habitYes5953.6
    No5146.4
    Mucus dischargeYes1917.3
    No9182.7
    ProctalgiaYes3027.3
    No8072.7
    Pruritus aniYes109.1
    No10090.9
    HaemorrhoidsYes2522.7
    No8577.3
    Mass or prolapseYes76.4
    No10393.6
    Family history of bowel cancerYes1311.8
    No9788.2
    • IBD = irritable bowel disease.

    • View popup
    Table 2. Significant abnormality, defined as polyps, inflammation, or cancer, identified by the primary care physician at the time of the LumenEye examination (N = 110 patients), compared with the findings of follow-up investigation or expert review, and sensitivity, specificity, positive predictive value, and negative predictive value of the LumenEye in the identification of pathology compared with subsequent colonoscopy, flexible sigmoidoscopy, or CTVC findings
    Pathology recorded, nCancerPolypInflammation
    Identified in primary care2616
    Identified after formal investigation or expert review of recorded images21115
    All patients Any pathology Cancer Polyp Inflammation
    TP, n 9254
    TN, n 32464541
    FP, n 4013
    FN, n 1010
    Sensitivity = TP/TP + FN, %90.010083.3100
    Specificity = TN/TN + FP, %88.910097.893.2
    PPV = TP/(TP + FP), %69.210083.357.1
    NPV = TN/(TN + FN), %97.010097.8100
    Patients presenting with rectal bleeding ( n = 28) Any pathology Cancer Polyp Inflammation
    TP, n 8234
    TN, n 15252421
    FP, n 4013
    FN, n 1010
    Sensitivity = TP/TP + FN, %88.910075.0100
    Specificity = TN/TN + FP, %78.910096.087.5
    PPV = TP/TP + FP, %66.710075.057.1
    NPV = TN/(TN + FN), %93.810096.0100
    • CTVC = computed tomography virtual colonoscopy. FN = false negative. FP = false positive. NPV = negative predictive value. PPV = positive predictive value. TN = true negative. TP = true positive.

Supplementary Data

  • Kinross_BJGPO.2022.0036.pdf -

    Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.

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A novel digital rectoscope for the triage of lower gastrointestinal symptoms in primary care: a prospective multicentre feasibility study
James Lewis, Alan Askari, Arihant Mehta, Yasmin Razak, Prash Patel, Ravi Misra, Henry Tilney, Tanveer Ahmed, Mooyad Ahmed, Adnan Syeed, John Camilleri-Brennan, Ralph John Nicholls, James Macalister Kinross
BJGP Open 2022; 6 (3): BJGPO.2022.0036. DOI: 10.3399/BJGPO.2022.0036

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A novel digital rectoscope for the triage of lower gastrointestinal symptoms in primary care: a prospective multicentre feasibility study
James Lewis, Alan Askari, Arihant Mehta, Yasmin Razak, Prash Patel, Ravi Misra, Henry Tilney, Tanveer Ahmed, Mooyad Ahmed, Adnan Syeed, John Camilleri-Brennan, Ralph John Nicholls, James Macalister Kinross
BJGP Open 2022; 6 (3): BJGPO.2022.0036. DOI: 10.3399/BJGPO.2022.0036
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Keywords

  • rectoscopy
  • general practice
  • family practice
  • colorectal
  • endoscopy
  • COVID-19

More in this TOC Section

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  • Variation in laboratory testing for patients with long-term conditions: a longitudinal cohort study in UK primary care
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