The Covid-19 health emergency has shocked all health care, not just that dealing with infectious diseases. And with an ongoing emergency, and far from over, it is necessary to rethink how to optimize services without leaving anyone behind. It is in this direction that the initiative of the British Health Service (National Health Service) which has just launched an extensive program of testing with videocapsule endoscopiche: just swallow a pill to perform an endoscopy, and thus highlight signs of tumors or other gastro-intestinal diseases.
The project – which, according to reports from the NHS, will involve over 11,000 patients in England – involves the use of a pill equipped with a camera. Once ingested, passing through the digestive tract, the pill takes pictures, intercepting the presence of any anomalies. The overall examination lasts a few hours, can be done at home, and the data acquired by the capsule is sent to a hard disc that the patient wears. All without the need to stay in a health facility, thus relieving the health system already tried by the emergency and slowed down by all the anti-contagion procedures. “Such a strategy can potentially make a huge difference for people with bowel cancer symptoms and could help the health system prioritize those in need of further testing,” says Genevieve Edwards, Chief Executive of Bowel Cancer UK.
The risk of late diagnosis
The risk that the burden of Covid-19 also affects oncology, with skipped screening and appointments, is real: in Italy, for example, 1.4 million screenings were skipped in the first months of last year. “At our facility alone, in the first four months of 2020 we had a reduction in diagnoses of cancer and advanced lesion tool of the colon of 80% and 78% respectively compared to the same months of the previous year”, confirms Cristiano Spada, professor at the Catholic University of the Sacred Heart and director of Digestive Endoscopy at the Poliambulanza Foundation in Brescia, recalling how colorectal cancers are second for incidence and mortality in our country. And a program like the one started by the NHS could help and make a difference in times like these, explains the expert.
The video capsule as an alternative to colonoscopy
In itself, the idea of the endoscopic pill, a capsule roughly the size of a large antibiotic, is far from new. He is at least twenty years old, continues Spada, recalling the revolutionary role that the video capsule had in the study of the small intestine even before that of the colon. More innovative is its application on such a large scale, accelerated by the pandemic. In fact, the promises of the video capsule as a tool to streamline the demand for colonoscopies have been discussed for some time: “The video capsule allows you to perform endoscopies in a non-invasive way, with fewer side effects, and substantially with diagnostic accuracy comparable to that of traditional methods – Spada – for this reason, for some time now, especially in countries such as England and more generally in Northern Europe, solutions have been sought that are capable of increasing the offer in the face of high needs ”. The one with a video capsule and the traditional colonoscopy, in fact, remain partly different tests: “Colonoscopy with video capsule allows you to make only a diagnosis, as opposed to the traditional one which, if necessary, can also be used as a therapy, for example for the elimination of any polyps “. In this way, even if only partially responding to diagnostic requests – the same ones that lead to a colonoscopy, such as pain, blood in the stool, diarrhea, to highlight the presence of neoplastic pathologies or chronic intestinal inflammatory diseases, for example – the video capsule free places for those who need endoscopy as a therapy, explains Spada. And all this becomes even more important in the Covid-19 era, the expert goes on: “If I can resort to an examination that is performed at home, I take patients out of hospitals. The real current limit to the widespread use of the video capsule is represented by the high costs “.
Limits and indications
The only substantial risk is represented by retention, explains Spada, but even in this case the non-expulsion is considered an adverse event, but also an indicator of a diagnosis, suggesting the presence of a pathological intestinal narrowing. Its absence of invasiveness, combined with safety make it a good alternative to diagnosis with colonoscopy, especially for some patients: “The indication to date is for those patients in whom colonoscopy is not possible because it is considered too invasive and not tolerable, or in which sedation cannot be applied due to the intake of certain drugs, or due to the presence of comorbidities. Or, again, in which the examination is not complete, that is, it has not been able to visualize up to the blind. In this case – concludes Spada – it is quite important, because we know that incomplete colonoscopies can be a risk factor for the so-called intervalar cancers, which appear between one examination and another ”.
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