RT Journal Article
SR Electronic
T1 A novel digital rectoscope for the triage of lower gastrointestinal symptoms in primary care: a prospective multicentre feasibility study
JF BJGP Open
JO BJGP Open
FD Royal College of General Practitioners
SP BJGPO.2022.0036
DO 10.3399/BJGPO.2022.0036
VO 6
IS 3
A1 James Lewis
A1 Alan Askari
A1 Arihant Mehta
A1 Yasmin Razak
A1 Prash Patel
A1 Ravi Misra
A1 Henry Tilney
A1 Tanveer Ahmed
A1 Mooyad Ahmed
A1 Adnan Syeed
A1 John Camilleri-Brennan
A1 Ralph John Nicholls
A1 James Macalister Kinross
YR 2022
UL http://bjgpopen.org/content/6/3/BJGPO.2022.0036.abstract
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.