Patient acceptability of an ingestible sampling and imaging capsule (Samplecam) for bowel surveillance and early detection of colorectal cancer among Lynch Syndrome patients: a focus group study

Natalie M Gil ^1* Samuel W D Merriel ² Heba Sailem ¹ Gerard Cummins ³ Elena Finn ⁴ Robert Kerrison ¹

• ¹ University of Surrey, Guildford, United Kingdom
• ² Centre for Primary Care and Health Services Research, University of Manchester, Manchester, England, United Kingdom
• ³ School of Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
• ⁴ Royal Marsden Hospital, London, United Kingdom

Lynch syndrome (LS) affects an estimated 1 in 279 people in the United Kingdom and presents a high lifetime risk of colorectal cancer. Current strategies to support early diagnosis include surveillance colonoscopy. Capsule endoscopy (CE) enables visualisation of the colon and rectum, using ingestible imaging devices, which could provide a means of enabling early detection between colonoscopies. Current CEs are limited to visual inspection and unable to obtain samples from the colon, requiring follow-up colonoscopy for biopsy. We have been developing a novel ingestible device, which 1) can collect samples from the colon and 2) utilises artificial intelligence to interpret images obtained. Perceived ease of use and usefulness will be key determinants of implementing ingestible devices within patient care. Adults living with LS participated in three online focus groups, comprising 14 participants. Attitudes toward a novel ingestible sampling and imaging device for use within the surveillance pathway were explored. The majority of participants were of White British ethnicity (n=13, 92.9%), female (n=13, 92.9%) and aged 35 years or older (n=10, 71.4%). We identified 11 barriers and five facilitators to use of the device. Further, we identified six advantages, one disadvantage, and four potential indications for use. Attitudes were positive towards the device. However, participants were opposed to the idea of this replacing colonoscopy. The device was seen as something that could be implemented to augment traditional surveillance methods and provide additional reassurance during long intervals between procedures. Results were consistent with previous findings that ingestible devices are perceived to be less invasive and represent an alternative for people who fear the discomfort and embarrassment of colonoscopy. Previous studies have identified the need for research with high-risk population groups. Our findings add to the literature by identifying several findings unique to LS patients; the recognition that inability to remove polyps (an important aspect of colonoscopy for LS patients) is a barrier to use. Second, ingestible devices may also fail to recognise polyps common in LS, such as those that are less pedunculated. Assurance around these issues will be required if implemented in the future.