A team in Scotland has been investigating this tiny technology since 2018, with hospitals in some parts of Scotland beginning to use the test in 2020.<\/p>\n
We spoke to them about what they\u2019ve learnt so far.<\/p>\n
A pill with potential<\/h2>\n
It all began with a list. An ever-growing list of people waiting for a colonoscopy \u2013 a type of endoscopy test used to diagnose bowel cancer, amongst other things.<\/p>\n
Something needed to be done.<\/p>\n
\u201cI spotted the opportunity and the future potential for using capsule endoscopy to look for bowel cancer,\u201d said Professor Angus Watson, a consultant bowel cancer surgeon at NHS Highland. \u201cI had a vison about the being made so accessible and highly acceptable to patients, that it could change the incidence of colorectal cancer in the UK .\u201d<\/p>\n
Colon capsule endoscopy looked like the right candidate. It was already being used in the NHS for people who were unable to have a colonoscopy, but so far it\u2019s use had been limited.<\/p>\n
\u201cThe technology itself was fairly well evaluated, just not widely used in clinical practice yet,\u201d says Anna Betzlbacher, a national improvement advisor for the Scottish Government. \u201cAnd what the team did was look at how you could deliver it best \u2013 how do you make sure it\u2019s a diagnostic pathway that can be sustainably delivered within the NHS?\u201d<\/p>\n
The SCOTCAP<\/a> team, led by Professor Angus Watson, worked with 3 Health Board areas across the North of Scotland to answer exactly that.<\/p>\n Dr Marilyn Lennon, an expert in digital health and wellness at the University of Strathclyde, worked with Watson on the evaluation. \u201cWe needed to not only clinically evaluate the test, but we also needed to test if patients actually like it. And if they\u2019re going to accept it as part of the service.\u201d<\/p>\n Lennon was responsible for the latter. \u201cI evaluated patient acceptance, which thankfully was thought of as really important, which isn\u2019t always the case.\u201d<\/p>\n According to Lennon, teams are often entirely focused on making sure new tests are clinically safe and effective. \u201cAnd that\u2019s all well and good. But if we find that this is going to radically improve our waiting lists, but all the patients say that it was awful and they would refuse it, then the whole thing falls apart.\u201d<\/p>\n Fortunately, this was not the case for colon capsule endoscopy.<\/p>\n \u201cThere were loads of really positive responses around being closer to home, not burdening the family \u2013 one person said she didn\u2019t have to get her husband to drive her all the way to Inverness for the test,\u201d says Lennon.<\/p>\n And while the test is a lot less invasive than a traditional colonoscopy, it\u2019s not as simple as it may sound, something that came through strongly in the evaluation .<\/p>\n \u201cIt\u2019s not just popping a pill, there\u2019s still a bowel prep, right? It\u2019s still a complicated procedure.\u201d Some people thought they would just be in, out and then they\u2019d get their results. But it wasn\u2019t like that.\u201d<\/p>\n Credit: Medtronic<\/span><\/p>\n<\/div>\n The test involves swallowing a small pill that contains a small disposable camera, which travels along your gut and takes thousands of pictures. These are transmitted to a data recorder that you wear on your waist.<\/p>\n Before the test, you\u2019re normally asked to eat a low fibre diet for around 5 days before the test, as well as taking medicine to empty your bowels as part of the bowel prep. You\u2019ll also need to take more medicine on the day of the test to help the camera to pass through smoothly.<\/p>\n<\/div>\n Feedback like this was vital for the team. Game-changing in fact. \u201cAs part of the test, you\u2019ve got to wear a shoulder bag to allow the photos to be transmitted and stored,\u201d says Lennon. \u201cAnd early on, there was a bit of negativity around some of the recording equipment, that it was cumbersome, a bit heavy for some people. In response, the company redesigned that and looked at making it lighter.<\/p>\n \u201cNow if you\u2019re doing a clinical trial, it wouldn\u2019t have been possible to change anything until the very end, quite rightly. But we\u2019re reacting to the things that were being said. So for me, that was a small but really amazing example of why this type of real-time evaluation needs to happen in healthcare.\u201d<\/p>\n The team also learnt how important it was to manage people\u2019s expectations, particularly around waiting . \u201cWhile the test can be delivered quite quickly, someone still needs to take a look at the images , it\u2019s not instant.<\/p>\n \u201cThe other thing is if you have the colon capsule endoscopy, you might still need to go for a colonoscopy, depending on the results ,\u201d Lennon adds.<\/p>\n Lennon says that by identifying these niggles at the very beginning, the team could improve the way the service was delivered and hopefully provide a roadmap for other countries who are implementing the technology too.<\/p>\n And while the formal evaluation period is over, the team are still learning.<\/p>\n \u201cWe\u2019re really trying to capture patient feedback even though the initial evaluation is over. We have a questionnaire that\u2019s handed out to every patient and two thirds of patients are returning it.\u201d<\/p>\n Betzlbacher says they\u2019re using the feedback to improve the service, for example changing the bowel prep medication people need to take before the test to one with a different flavour and that requires a reduced amount of liquid.<\/p>\n \u201cWe\u2019re looking to keep evolving and adapting but I think now we\u2019ve moved into the adoption phase it\u2019s the little things now to make sure the service works and keeps on improving \u2013 both from a patient and NHS view \u2013 and see how endoscopy teams start to use the new service and learn which patient groups benefit most from the new test.\u201d<\/p>\n Lennon says while subtle, the ongoing evaluation being done through surveys is \u201cgenius\u201d.<\/p>\n \u201cIn normal life you go to the GP and get a drug or a new armband to wear and that\u2019s fine, it\u2019s just part of the NHS service. But to actually have service evaluation as part of it, that\u2019s amazing \u2013 because then you\u2019re giving feedback to the company, to the NHS, to the government on what you liked and what you didn\u2019t.<\/p>\n \u201cTo some people that sounds too consumery, but why should we not be able to say what we did and didn\u2019t like about the service?\u201d<\/p>\n Fast. Responsive. Patient-centric. Qualities that anyone would want when it comes to bringing new tests into a healthcare system. The team credit the people and partners involved for their success \u2013 made possible through an innovation partnership model that included the company that makes PillCam<\/a>, the NHS, academic researchers, a company that managed the service<\/a> and one that designed the software<\/a> for the service, amongst others.<\/p>\n \u201cEveryone went on the journey at the same time, meaning we could fix what\u2019s not working,\u201d says Lennon. \u201cIt\u2019s a brilliant model for trying to get new technologies out.\u201d<\/p>\n Betzlbacher agrees. \u201cThe team really started with the endpoint in mind \u2013 they started testing out the service model to scale it up and roll it out across the country. And that really enabled us to quickly move from evaluation to roll out.\u201d<\/p>\n The team say this model could be particularly useful for smaller medtech companies, which have sometimes struggled to make inroads with the NHS in the past, by breaking down barriers and making sure the right expertise are there.<\/p>\n \u201cThe NHS needs to become more agile \u2013 with innovation in its DNA,\u201d says Watson. \u201cBy working with med tech companies. the NHS can solve clinical problems but can also create economic health; this has happened in the ScotCap programme. Giving smaller medtech companies direct access to clinicians definitely breaks down the silos.\u201d<\/p>\n \u201cWhen I first came into this, I was telling people \u2018this is a replacement for colonoscopies. It\u2019s brilliant, imagine having this instead of a colonoscopy.\u2019 But very quickly I realised it wasn\u2019t that simple,\u201d says Lennon. \u201cIt\u2019s not going to solve everything, but if you can identify the group that are really going to get an advantage then that\u2019s great.\u201d<\/p>\nWhat does a colon capsule endoscopy involve?<\/h3>\n
![\"\"](\"https:\/\/zniup3zx6m0ydqfpv9y6sgtf-wpengine.netdna-ssl.com\/wp-content\/uploads\/2021\/04\/Pillcam-in-colon-medtronic.jpg\")
<\/p>\nRoll out<\/h2>\n
What\u2019s next<\/h2>\n