• COVID-19
• endoscopy
• endoscopic procedures
• cancer
• colonic adenomas

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 …