Piloting Colon Capsule Endoscopy (CCE) in Wales

National Endoscopy Programme/Betsi Cadwaladr University Health Board, Cwm Taf Morgannwg University Health Board, Swansea Bay University Health Board and Cardiff & Vale University Health Board

Professor Sunil Dolwani, Clinical Reader and Consultant Gastroenterologist

Dana Knoyle, Managerial and Nurse Lead for Clinical Pathways, National Endoscopy Programme

Naomi Davies, Senior Project Manager, National Endoscopy Programme

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 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.

Anticipated outcomes

  1. The rapid implementation of an innovative, prudent solution to contribute to national capacity issues for colonoscopy and a concomitant reduction of waiting times across Wales to mitigate the impact and improve patient outcomes for colorectal cancer in Wales.
  2. A robust national-level data analysis and evaluation within a standardised framework demonstrating benefits for patients and healthcare providers leading to evidence-based recommendations for further investment and implementation in sustainable patient pathways.