Patient experience of colon capsule endoscopy in clinical practice::a structured, comparative patient survey

Objective Colon capsule endoscopy (CCE) is a recognised diagnostic tool, but there is little research exploring patient experience of this relatively new technology. We aimed to understand the patient experience of CCE and explore similarities to and differences from colonoscopy and CT colonography (CTC). Methods We conducted a structured patient experience survey exploring preprocedural, procedural and postprocedural elements of CCE, alongside colonoscopy and CTC, using descriptive statistics. Consenting patients were recruited from the NHS England CCE pilot, referred either on a suspected colorectal cancer or a 3-year postpolypectomy surveillance pathway. Results 927 of 1937 patients (48%) responded to the survey invitation. 486 had CCE as their index procedure, 399 colonoscopy and 42 CTC. Two per cent of CCE patients found the procedure painful compared with 21% of colonoscopy and 12% of CTC patients (p<0.001). The CCE procedural information was easily understood by 81% of patients compared with 92% having colonoscopy (p<0.001). There was no significant difference in the bowel preparation experience with 20% of CCE and 16% of colonoscopy patients experiencing severe or more discomfort (p=0.439). However, 19% of CCE patients felt the bowel preparation would put them off a future CCE compared with 8% of colonoscopy patients (p<0.001). This was not wholly explained by the need for further investigations. Using regression analysis, we found that high-quality preprocedural information, tolerability of bowel preparation, procedural comfort and investigative closure were predictors of patient satisfaction with CCE. 74% of patients were satisfied with CCE in diagnosing or reassuring them compared with 91% in colonoscopy and 80% in CTC (p<0.001). Conclusions CCE was similarly or better tolerated than colonoscopy and CTC throughout the patient journey, with significantly less pain experienced. A future CCE clinical service should ensure that the patient is well informed and optimise the likelihood of the investigative closure.