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

Author(s): James Lewis, Alan Askari, Arihant Mehta, et al
Source: BJGP Open 21 June; BJGPO.2022.0036
Abstract:
Adults meeting two week wait (2WW) criteria for suspected lower GI cancer or 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 114 patients were recruited (46 (40%) females: 68 (60%) males). No serious adverse events were reported. 82 (75%) patients reported that examination was more comfortable than expected, 104 (94%) felt intervention was most convenient if delivered in the community. Clinicians were confident of their assessment in 100 (87%) examinations. Forty-eight (42.1%) patients subsequently underwent colonoscopy, flexible sigmoidoscopy, or CT virtual colonoscopy. The overall sensitivity and specificity of LumenEye® in identifying rectal pathology was 90.0% and 88.9%. It was 100%/100% for cancer, and 83.3%/97.8% for polyps. Following LumenEye® examination, 19 (17%) patients were discharged, with projected savings of £11,305.
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.
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