A study of a new technique to examine the bowel for polyps during a bowel cancer screening test (The INWARD study)

Please note - this trial is no longer recruiting patients. We hope to add results when they are available.

Cancer type:

Bowel (colorectal) cancer
Colon cancer





This study is to see if it is possible to find more polyps during bowel scope screening using a new technique. It is for people who have been referred to St Mark’s Hospital in London as part of the national bowel screening programme.

Polyps are growths inside the bowel. Most bowel cancers start when a type of polyp called an adenoma becomes cancerous.

More about this trial

Screening means testing people for early stages of a disease before they have any symptoms. For bowel scope screening a specially trained doctor (or nurse) puts a thin flexible tube into your back passage. The tube has a tiny camera on the end so that the doctor can look inside the lower part of your large bowel. This test is also called a flexi scope or flexible sigmoidoscopy (flexi-sig).

The test looks for polyps. It can also find cancers if they have already developed and is likely to pick them up at an early stage. The doctor will usually remove any polyps straight away. Removing these growths reduces your risk of bowel cancer.

The usual way to examine the bowel is to put the scope in quickly and then look for polyps when the tube is withdrawn. But we know from recent research that it is only possible to see some polyps when the tube is put into the bowel.

Researchers want to improve the number of polyps they find. In this study they are looking at a new way of doing the bowel examination. This involves looking for polyps as the tube goes in and as it comes out.

The aims of this study are to find out:

  • if the new technique finds more polyps
  • how long the new technique takes
  • if it makes a difference to people’s level of discomfort

Who can enter

The following bullet points list the entry conditions for this study. Talk to your doctor or the study team if you are unsure about any of these. They will be able to advise you.

Who can take part
You might be able to join this study if your doctor has already referred you for a bowel scope examination at St Mark’s Hospital, North West London.

Who can’t take part
You cannot join this study if any of these apply. You:

  • are under the age of 55
  • have a problem with blood clotting that can’t be controlled with medication
  • are not fit to have a bowel scope (a flexible sigmoidoscopy)
  • are pregnant 

Trial design

This study is taking place at St Mark’s Hospital, London. The researchers would like about 478 people to take part.

It is a randomised trial. You are put into 1 of 2 groups. Neither you nor your doctor can choose which group you are in.

You are put into 1 of the following groups to have:

  • the bowel scope using the new technique
  • the bowel scope in the usual way (the control group Open a glossary item)

New technique
The doctor examines your bowel as the tube goes in and when it comes out.

Usual way
The doctor examines your bowel when they withdraw the tube.

The time to complete the procedure is the same in both groups. The doctor makes a note if they find polyps as the scope goes in or comes out.

Hospital visits

You have the bowel scope examination at the hospital. But you don’t have any extra hospital visits if you take part in this study.

Side effects

There are no extra side effects if you take part in this study.

Having a bowel scope is usually very safe. But there is risk that the scope could damage your bowel. The study team will explain the risks of this bowel scope screening.

We have more information about bowel screening.

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Professor Brian Saunders

Supported by

London North West Health Care NHS Trust

If you have questions about the trial please contact our cancer information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:


Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Last reviewed:

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