Colon Capsule Endoscopy (CCE) is a minimally invasive alternative to standard colonoscopy. It was introduced in 2021 as part of an NHS pilot scheme with fifty other hospitals. In this pilot, 70% of patients did not require a subsequent colonoscopy, and a substantial proportion of the remaining 30% were downgraded to non-urgent¹. CCE is now established as a routine service nationally.

CCE presents significant advantages when compared to traditional colonoscopy. When bowel preparation is adequate and the study is completed, it demonstrates a high sensitivity for polyps and malignancy that is comparable to colonoscopy². It is generally well-tolerated, with low complication and discomfort rates³. Finally, CCE may contribute to addressing long waiting lists and capacity pressures with colonoscopy.

Our Trust is one of the highest-volume sites nationally for delivering CCE. This analysis reviews all CCE reports since the commencement of the service at our Trust to assess its impact and how it can be used to benefit different patient groups.

We reviewed all CCE reports between January 2021 and September 2025. Eligible patients included those referred via the 2-week-wait (2WW) colorectal cancer pathway who were considered lower risk (faecal immunochemical testing (FIT) of <100). The reasons for referral, specifically the presence of NG12 symptoms such as rectal bleeding or a change in bowel habit, were recorded. A CCE was also offered if a colonoscopy was contraindicated or had previously failed, or on the basis of patient preference. Biochemistry and demographic data were recorded. Bowel preparation was scored using the Boston Bowel Preparation Scale, with the CCE marked as complete if a satisfactory view of all sections of the colon was achieved. If the study was marked as incomplete, the subsequent investigation was reviewed. CCE findings, normal study rates and whether the patient was stepped down from the 2WW pathway were also documented.

473 CCE cases were analysed in total. The male to female ratio was 214:259. The median age was 57 (IQR = 20). 385 patients (81%) were White British. 76 (16%) belonged to an ethnic minority, and 12 (3%) did not have an ethnicity recorded.

The most common reason for referral was a change in bowel habit (n=285). Other indications were weight loss (n=75), rectal bleeding (n=175), abdominal pain (n=176) and anaemia (n=93). In the latter case, only 89 patients had biochemical evidence of anaemia on referral. Patients could have more than one referral symptom.

FIT was positive in 256 patients. The mean FIT with 22.5, with a similar average of 22.9 in over 70s. The median bowel preparation score was 8 (IQR = 3).

402 CCEs (84.9%) were marked as completed, with 349 patients (73.8%) stepped down from the 2WW pathway. 102 patients (21.6%) had a subsequent colonoscopy, including 60 for polypectomy. 32 patients had a flexible sigmoidoscopy following CCE for completion of imaging.

No abnormality was identified in 98 (20.6%) patients. In the remaining patients, diagnoses identified included polyps (n=141), diverticulae (n=159), haemorrhoids (n=42), colitis (n=19), ulcer (n=17), telangiectasia (n=11) and malignancy (n=1).

74 CCEs (15.6%) were marked as incomplete. The most common reason for this was inadequate bowel preparation (n=52). Other causes were the battery running out (n=17), rapid transit (n=2), a camera error (n=2) and gastric retention (n=1).

CCE has been successfully introduced at our site, demonstrating a similar stepdown rate to published studies and a completion rate that exceeded the rate reported in the national pilot. Further investigations were not required in more than 70% of patients. These findings reaffirm the role of CCE in reducing pressure on colonoscopy services, in this case by identifying and investigating lower risk patients.