The University of Warwick and University Hospitals Coventry and Warwickshire (UHCW) NHS Trust are investigating whether a new dual testing method can improve the diagnostic accuracy for patients with suspected significant bowel disease (SBD) – without the need for a colonoscopy.
The ‘REducing Colonoscopies in Patients without Significant BowEl DiseasE’ (RECEDE) study is set to recruit 1,819 patients who are referred for colonoscopies at participating sites within the UK due to persistent lower gastrointestinal symptoms.
RECEDE will introduce urinary volatile organic compound (VOC) analysis alongside faecal immunochemical testing (FIT) to detect patients who do or do not have SBD, including colorectal cancer, before a colonoscopy is required.
Should the study be a success, the testing method could reduce the demand for colonoscopies in NHS Trusts across the UK, which can be invasive and uncomfortable for patients and have high cost implications for the NHS.
Coventry resident John Todd, who was diagnosed with a Neuro Endocrinal Tumour in 2013 and is a member of the UHCW NHS Trust Research Advisory Group, believes the research could prove to be hugely beneficial to patients and the standard of care they receive.
The 65-year-old said: “Anticipation of and preparation for a colonoscopy were the worst parts of the diagnostic process for me and a colonoscopy can be uncomfortable. Reducing the numbers who have to go through this process would be a significant step forward in improving patient care.”
Currently all patients who are referred to hospital with lower gastrointestinal symptoms receive a colonoscopy. Of these, only around 30% have a serious condition while the remainder either have benign conditions or no problems whatsoever.
Study participants will see no change to the standard of care they receive and will only be asked to provide a stool and urine sample prior to having their colonoscopy. Samples will be sent for analysis where the results will be compared to the histology findings of the colonoscopies.
A subset of participants will be asked to complete questionnaires surrounding their colonoscopy to further examine how the procedure affects a patient’s quality of life.
RECEDE has been set up by Professor and Consultant Gastroenterologist Ramesh Arasaradnam with the support of the in house Trial Management Unit at the sponsor site UHCW NHS Trust, which has received funding from the National Institute for Health Research (NIHR) for the project.
Professor Arasaradnam, who is an honorary clinical academic at Warwick Medical School, said: ”This important study supported by the NIHR seeks to evaluate stool FIT and urine volatile markers to detect those with SBD. It is anticipated we will be able to identify those at risk of SBD and prioritise this group to have a colonoscopy.
“Reducing unnecessary colonoscopies has important implications, especially in the COVID era. We envisage results from this study will help cancer alliances and commissioning groups streamline clinical pathways and also guide NICE in any future recommendations.”
The RECEDE study is being conducted in collaboration with the University of Warwick, the University of Manchester and the University of Leeds.
Notes: The National Institute for Health Research (NIHR) is the nation’s largest funder of health and care research. The NIHR:
- Funds, supports and delivers high quality research that benefits the NHS, public health and social care
- Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
- Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
- Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
- Partners with other public funders, charities and industry to maximise the value of research to patients and the economy
The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.
FIT and VOC
FIT detects the quantity of haemoglobin within a stool sample while VOC analysis measures the composition of specific metabolites, which are produced as a response to inflammation when disease is present, within the urine.
About UHCW NHS Trust
University Hospitals Coventry and Warwickshire (UHCW) NHS Trust is one of the largest acute teaching Trusts in the UK, comprising University Hospital in Coventry and the Hospital of St Cross in Rugby and working in partnership with Warwick University Medical School and Coventry University.
It has over 9,000 staff and delivers services across the West Midlands region. This includes hosting region-wide services such as the Coventry and Warwickshire Pathology Network and the North West and Midlands Bowel Cancer Screening hub. The Trust works closely with its partners in health and social care in Coventry/Warwickshire to develop patient-focused services that meet the needs of communities.
The Research and Development Department at the Trust supports and delivers a wide range of high quality health research for the benefit of our patients. In 2019-20, the department recruited 4,295 patients into research projects – demonstrating the Trust’s commitment to improving the quality of care and contributing to wider health improvement.
The team recruited more COVID-19 patients per head of population than the national average, supporting the World Health Organisation ‘ISARIC’ trial and the National Institute for Health Research ‘Recovery’ study which demonstrated the efficacy of low dose Dexamethasone as an effective treatment for COVID-19.