The freeze on endoscopy activity during the first wave of the COVID-19 pandemic was followed by radical pathway redesign to minimise risks of viral transmission. However, most endoscopy lists are running at reduced capacity due to the need for extra safety measures, staff absences and there is a concern about a post-COVID surge in demand as symptomatic patients emerge from isolation. ‘Desperate times call for desperate measures’: to mitigate pressures on endoscopy services the British Society of Gastroenterology Endoscopy committee set up a COVID-19 Research Group to consider potential roles for novel alternative diagnostic technologies and National Health Service (NHS) England has provided £6 million to deliver colon capsule endoscopy services over the next year. Could this terrible pandemic be the impetus needed for capsule endoscopy to replace conventional endoscopy as the primary diagnostic tool? ‘In the midst of every crisis lies great opportunity.’ Most clinicians remain hesitant about embracing capsule endoscopy of the colon or upper gastrointestinal (GI) tract, although small bowel examination is widely accepted. Colonoscopy is performed in 1.5% of the population per annum, demand is increasing, it is undignified and uncomfortable and often necessitates the use of sedatives and analgesia. About 90% of procedures reveal no clear cause for symptoms although incidental polyps are found in 20%.1 It is hoped that biomarker assays such as the faecal immunochemical test (FIT) for haemoglobin and calprotectin may help select appropriate patients who need colonoscopy for biopsy or polypectomy. However, in setting FIT and calprotectin referral thresholds there is a trade-off between reducing referral rate and increasing pathology miss rate which puts patients and clinicians in a dilemma. Not …

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COVID-19：推动采用胶囊内窥镜作为主要诊断工具？


第一波 COVID-19 大流行期间内窥镜检查活动被冻结，随后进行了彻底的途径重新设计，以最大限度地降低病毒传播的风险。然而，由于需要额外的安全措施、工作人员缺勤，而且人们担心，随着有症状的患者摆脱隔离，新冠病毒后需求激增，大多数内窥镜检查清单的容量都在减少。 “绝望的时刻需要绝望的措施”：为了减轻内窥镜服务的压力，英国胃肠病学内窥镜委员会成立了一个 COVID-19 研究小组，以考虑新型替代诊断技术的潜在作用，英国国家医疗服务体系 (NHS) 已提供英镑明年将投入 600 万美元提供结肠胶囊内窥镜服务。这次可怕的流行病是否会成为胶囊内窥镜取代传统内窥镜作为主要诊断工具所需的动力？ “每一次危机中都蕴藏着巨大的机遇。”尽管小肠检查已被广泛接受，但大多数临床医生对于接受结肠或上胃肠道 (GI) 的胶囊内窥镜检查仍犹豫不决。每年有 1.5% 的人口接受结肠镜检查，需求量不断增加，这种检查有损尊严且不舒服，并且常常需要使用镇静剂和镇痛剂。尽管 20% 的患者发现了偶发性息肉，但约 90% 的手术并未发现明确的症状原因。1 希望生物标志物检测（例如针对血红蛋白和钙卫蛋白的粪便免疫化学检测 (FIT)）可以帮助选择需要结肠镜检查进行活检的合适患者或息肉切除术。 然而，在设定 FIT 和钙卫蛋白转诊阈值时，需要在降低转诊率和增加病理漏诊率之间进行权衡，这使患者和临床医生陷入两难境地。不是 …