Groundbreaking new method of detecting bowel cancer (1)

Research into and development of investigations and treatments to advance patient care across a wide range of specialties has continued, despite the demands on the NHS posed by Covid-19, and County Durham and Darlington has been chosen as one of a few pilot sites for a new technique to investigate bowel symptoms.

Dr Francisco Porras-Perez, Consultant Gastroenterologist/Endoscopist, with County Durham and Darlington NHS Foundation Trust, explains, "Patients referred to us with symptoms such as a recent change in bowel habits - which could be linked to bowel cancer or other bowel conditions - will often have a colonoscopy.  This test involves passing a long, thin, flexible tube with a small camera on it, either down through the patient's mouth or through their rectum, into their bowel.  Whilst this is a very useful and effective investigation that enables clinicians to see what's going on, it can be uncomfortable, indeed some patients are unable to tolerate the procedure and for others, their anatomy can make viewing the whole bowel difficult, even impossible.

"So, we're very excited to have been chosen by NHS England as one of just over 40 centres to pilot an amazing new technique - Colon Capsule Endoscopy - which  involves a tiny disposable camera, that's small enough to swallow easily and powerful enough to help rule out bowel cancer and other problems of the gastro intestinal tract. Initially, as part of the routine bowel screening programme, patients will continue to submit a poo sample for analysis - to help determine whether further investigation is necessary.

"As with colonoscopy, Colon Capsule Endoscopy, requires the patient to take a preparation at home the day before the procedure to help empty their bowels.  They then attend a clinic where they swallow the miniature camera, which is no larger than many tablets, with water.   The capsule contains two tiny cameras which take many thousands of images of the bowel as the capsule passes through the gastro-intestinal tract - from oesophagus, stomach, duodenum small and large bowel.  The patient wears a small shoulder bag containing a data recorder and the images are transmitted from the camera to the recorder, where they're stored.  The camera then leaves the body when the patient next goes to the toilet within hours in the majority of cases.  We either collect, or the patient returns, the data recorder to us and we then download the images onto a computer using specially developed software to read every photo, identifying those showing something out of the ordinary and that need to be looked at more closely.  I then take a more detailed look at these images, having had sufficient experience and specialist training in this through an advanced reader training course at The Royal Free Hospital, London.  

"In some cases, colon capsule endoscopy can also replace CT and other scans which, though non-invasive, expose patients to some radiation.  It could be particularly useful, for example, for people who need regular check-up or monitoring scans, to avoid repeat radiation exposure.

"I understand that some people may by nervous about swallowing the capsule, but it really is tiny and can be easily swallowed with a glass of water.  In time, we hope patients will be able to swallow the capsule at home, in their GP practice or a community hospital - whichever is most convenient.  It really won't need to be overseen by a clinician.  They can then just go about their daily lives - albeit wearing the data recorder in the shoulder bag we'll provide.  A colonoscopy, on the other hand, usually involves around two hours in hospital, with the colonoscopy itself taking 35-45 minutes.  Some patients require sedation in order to tolerate the procedure which means someone needs to take them home and, although rare, some patients experience bleeding or discomfort following a colonoscopy.  Although colonoscopy is a very useful diagnostic tool, we are incredibly excited that many of our patients will, through our involvement in this pilot, benefit from the convenience of colon capsule endoscopy. 

"Bowel cancer is one of the four cancers that account for more than 50% of all cancer diagnoses in the UK and early identification can significantly improve the outcome for patients.  So investigating symptoms is important, meaning there's high demand on our services - including the bowel cancer screening programme for those over 55.  Using this new technique which usually requires a 15 minute appointment rather than at least 45 minutes, plus the recovery time required for colonoscopy will, at the very least, reduce waits for patients and the need for them to attend hospital.

"I've been performing colonoscopies for over 18 years and know how effective they are as a diagnostic tool, but using the capsule will be a significant step forward.

"Thankfully, around 60% of investigations for bowel cancer are negative and our hope is that, using this time saving technique for the initial investigation will enable us to focus clinical time and expertise on the other 40% of patients who need further care.

"Ensuring patients have a positive experience, as well as excellent clinical care, is also very important to us and we'll be asking patients for their detailed feedback as part of the pilot to inform learning and any changes going forward. 

24 June 2021