PT - JOURNAL ARTICLE AU - Lewis, James AU - Askari, Alan AU - Mehta, Arihant AU - Razak, Yasmin AU - Patel, Prash AU - Misra, Ravi AU - Tilney, Henry AU - Ahmed, Tanveer AU - Ahmed, Mooyad AU - Syeed, Adnan AU - Camilleri-Brennan, John AU - Nicholls, Ralph John AU - Kinross, James Macalister TI - A novel digital rectoscope for the triage of lower gastrointestinal symptoms in primary care: a prospective multicentre feasibility study AID - 10.3399/BJGPO.2022.0036 DP - 2022 Sep 01 TA - BJGP Open PG - BJGPO.2022.0036 VI - 6 IP - 3 4099 - http://bjgpopen.org/content/6/3/BJGPO.2022.0036.short 4100 - http://bjgpopen.org/content/6/3/BJGPO.2022.0036.full SO - BJGP Open2022 Sep 01; 6 AB - Background Access 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.Aim To determine if digital rectoscopy is feasible, acceptable, and clinically safe.Design & setting Evaluation of clinician case reports and patient questionnaires from patients recruited from five primary care centres.Method Adults 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.Results A 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.Conclusion Digital 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.