{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T18:57:08Z","timestamp":1781204228885,"version":"3.54.1"},"reference-count":24,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,27]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction and objective<\/jats:title>\n                    <jats:p>Organ preservation strategies for rectal cancer following neoadjuvant treatment require intensive endoscopic monitoring to detect early luminal recurrence. This is termed 'Watch and Wait' (WAW). Standard protocols commonly mandate flexible sigmoidoscopy every 3\u20134 months for 2 years. Digital proctoscopy with the LumenEye device has been shown to be a safe alternative that can be performed in an outpatient setting without the need for sedation and with less staffing requirements. The study objective is to evaluate the economic implications of using digital proctoscopy compared with flexible sigmoidoscopy for patients with rectal cancer managed under a WAW protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and design<\/jats:title>\n                    <jats:p>The study was conducted in a secondary care National Health Service (NHS) setting. A cost comparison analysis was performed over a 2\u2009year time horizon (seven procedures per patient). 177 procedures on rectal cancer patients undergoing WAW with digital proctoscopy between August 2023 and November 2024 were included. The control group, that is, flexible sigmoidoscopy was modelled. The base case was flexible sigmoidoscopy without sedation. Scenarios using sedation were also evaluated. Costs were categorised into fixed and variable costs. A one-way sensitivity analysis, probabilistic sensitivity analysis and What-If scenarios were also performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures and results<\/jats:title>\n                    <jats:p>The primary outcome was the minimum cost difference between the two procedures. The secondary outcome measure was the robustness of the cost differences. Over 2 years, the total cost per patient was \u00a3768.92 (95% CI \u00a3656.6 to \u00a3900.7) for digital proctoscopy compared with \u00a31,588.15 (95% CI \u00a31458.1 to \u00a31725.2) for flexible sigmoidoscopy without sedation. The absolute minimum cost saving per patient is \u00a3820.23 (95% CI \u00a3648.7 to \u00a3985.1). Cost savings increased to \u00a3848.94 (95% CI \u00a3677.20 to \u00a31013.83) to \u00a3935.62 (95% CI \u00a3761.02 to \u00a31103.08) when sedation was used in flexible sigmoidoscopy procedures. Personnel costs during the procedure and recovery phase were the dominant cost drivers for flexible sigmoidoscopy. Probabilistic sensitivity analysis and What-If scenarios confirmed the robustness of the findings, with flexible sigmoidoscopy remaining more costly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Digital proctoscopy with the LumenEye device is a cost-saving alternative to flexible sigmoidoscopy for patients with rectal cancer on a WAW protocol. Our findings support the integration of digital proctoscopy into WAW pathways as a cost-efficient alternative within resource-constrained healthcare systems. Endoscopy service pressures are also likely to be alleviated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-119490","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T18:00:41Z","timestamp":1781200841000},"page":"e119490","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cost analysis of the use of digital rectoscopy versus flexible sigmoidoscopy in rectal cancer patients undergoing watch and wait"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7549-2933","authenticated-orcid":false,"given":"Harpreet Kaur","family":"Sekhon Inderjit Singh","sequence":"first","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London, London, UK"},{"name":"Department of Surgery, Buckinghamshire Hospitals NHS Trust, Amersham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly","family":"Harper","sequence":"additional","affiliation":[{"name":"Department of Surgery, Buckinghamshire Hospitals NHS Trust, Amersham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentin","family":"Butnari","sequence":"additional","affiliation":[{"name":"National Bowel Research Center, The Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London Centre for Neuroscience Surgery and Trauma, London, UK"},{"name":"Department of Colorectal Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Beni","sequence":"additional","affiliation":[{"name":"Department of Surgery, Buckinghamshire Hospitals NHS Trust, Amersham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio","family":"Lozano","sequence":"additional","affiliation":[{"name":"Department of Surgery, Buckinghamshire Hospitals NHS Trust, Amersham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnold","family":"Goede","sequence":"additional","affiliation":[{"name":"Department of Surgery, Buckinghamshire Hospitals NHS Trust, Amersham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"2026061111002581000_16.6.e119490.1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e3182a25c4e"},{"key":"2026061111002581000_16.6.e119490.2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.00032"},{"key":"2026061111002581000_16.6.e119490.3","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/j.ijrobp.2021.10.004","article-title":"Clinical Complete Response in Patients With Rectal Adenocarcinoma Treated With Short-Course Radiation Therapy and Nonoperative Management","volume":"112","author":"Chin","year":"2022","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2026061111002581000_16.6.e119490.4","doi-asserted-by":"crossref","DOI":"10.1007\/s10151-025-03279-0","article-title":"Evaluating the clinical use and safety of LumenEye in an outpatient colorectal clinic: a single-centre retrospective cohort study","volume":"30","author":"Beni","year":"2026","journal-title":"Tech Coloproctol"},{"key":"2026061111002581000_16.6.e119490.5","unstructured":"BMJ publishing group ltd and pharmaceutical press the RPS knowledge business. The British National Formulary. Available: https:\/\/bnf.nice.org.uk [Accessed 20 Dec 2025]."},{"key":"2026061111002581000_16.6.e119490.6","unstructured":"NICE technology appraisal and highly specialised technologies guidance: the manual. NICE Process and Methods; 2025."},{"key":"2026061111002581000_16.6.e119490.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2021.10.008"},{"key":"2026061111002581000_16.6.e119490.8","doi-asserted-by":"crossref","first-page":"127","DOI":"10.3393\/ac.2024.00584.0083","article-title":"Bedside endoscopic inspection of colorectal anastomoses in the early postoperative period: a 2-center prospective feasibility study","volume":"41","author":"Nijssen","year":"2025","journal-title":"Ann Coloproctol"},{"key":"2026061111002581000_16.6.e119490.9","doi-asserted-by":"crossref","unstructured":"Lewis J , Askari A , Mehta A , et al . A novel digital rectoscope for the triage of lower gastrointestinal symptoms in primary care: a prospective multicentre feasibility study. BJGP Open 2022;6. doi:10.3399\/BJGPO.2022.0036","DOI":"10.3399\/BJGPO.2022.0036"},{"key":"2026061111002581000_16.6.e119490.10","doi-asserted-by":"crossref","unstructured":"Briggs A , Claxton K , Sculpher M . Decision Modelling For Health Economic Evaluation. Oxford University PressOxford, 2006.","DOI":"10.1093\/oso\/9780198526629.001.0001"},{"key":"2026061111002581000_16.6.e119490.11","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000000368"},{"key":"2026061111002581000_16.6.e119490.12","doi-asserted-by":"crossref","first-page":"7798","DOI":"10.1245\/s10434-024-16037-7","article-title":"The Rise of Patients Declining Rectal Cancer Surgery in the Era of Total Neoadjuvant Therapy","volume":"31","author":"Hilty Chu","year":"2024","journal-title":"Ann Surg Oncol"},{"key":"2026061111002581000_16.6.e119490.13","doi-asserted-by":"crossref","first-page":"116154","DOI":"10.1016\/j.ejca.2025.116154","article-title":"Trends in organ preservation in rectal cancer management: A population-based study in the Netherlands","volume":"232","author":"Darai","year":"2026","journal-title":"Eur J Cancer"},{"key":"2026061111002581000_16.6.e119490.14","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1001\/jamaoncol.2023.4845","article-title":"Practice Patterns for Organ Preservation in US Patients With Rectal Cancer, 2006-2020","volume":"10","author":"Loria","year":"2024","journal-title":"JAMA Oncol"},{"key":"2026061111002581000_16.6.e119490.15","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1007\/s00268-020-05795-6","article-title":"A Snapshot of the International Views of the Treatment of Rectal Cancer Patients, a Multi-regional Survey: International Tendencies in Rectal Cancer","volume":"45","author":"Caycedo-Marulanda","year":"2021","journal-title":"World J Surg"},{"key":"2026061111002581000_16.6.e119490.16","unstructured":"British Society of Gastroenterology . Getting ahead of the curve: our vision for the future workforce. Available: https:\/\/www.bsg.org.uk\/BSG\/media\/BSG-Media\/PDFs\/BSG-AheadofCurveFINAL.pdf [Accessed 12 Dec 2025]."},{"key":"2026061111002581000_16.6.e119490.17","unstructured":"The NHS long term plan. 2019. Available: https:\/\/webarchive.nationalarchives.gov.uk\/ukgwa\/20230418155402\/https:\/www.longtermplan.nhs.uk\/publication\/nhs-long-term-plan"},{"key":"2026061111002581000_16.6.e119490.18","unstructured":"Patel A , Farrar H . Achieving the 18-week standard for elective care. 2024."},{"key":"2026061111002581000_16.6.e119490.19","unstructured":"The Labour Party . Labour party\u2019s manifesto 2024: \u2018Build an NHS fit for the future. 2024. Available: https:\/\/labour.org.uk\/change\/build-an-nhs-fit-for-thefuture"},{"key":"2026061111002581000_16.6.e119490.20","unstructured":"NHS employers: consultant contract (2003). 2024. Available: https:\/\/www.nhsemployers.org\/articles\/consultant-contract-2003"},{"key":"2026061111002581000_16.6.e119490.21","unstructured":"NHS employers, agenda for change. NHS Payscales; 2023. Available: https:\/\/www.nhsemployers.org\/articles\/pay-scales-202223-archived"},{"key":"2026061111002581000_16.6.e119490.22","unstructured":"Jones KC , Weatherly H , Chalkley A , et al . Unit costs of health and social care 2024 manual. technical report. Personal Social Services Research Unit (University of Kent) & Centre for Health Economics (University of York), Kent, UK. doi:10.22024\/UniKent\/01.02.10"},{"key":"2026061111002581000_16.6.e119490.23","unstructured":"LumenEye brochure. Available: https:\/\/www.surgease.com\/featured-products\/lumeneye [Accessed 1 Dec 2025]."},{"key":"2026061111002581000_16.6.e119490.24","unstructured":"NHS England: assets in action. an asset management guide for non-technical managers. 2021. Available: https:\/\/www.england.nhs.uk\/publication\/assets-in-action-an-asset-management-guide-for-non-technical-managers"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-119490","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T18:00:48Z","timestamp":1781200848000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-119490"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":24,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,11]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/bmjopen-2026-119490"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-119490","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]}}}