Introduction With 18 weeks pathways as the maximum for NHS treatment, pressures on initial diagnostic intervention has increased enormously. Endoscopy is a key part of the gastroenterology service and is the main diagnostic tool for gastrointestinal cancers. At the same time busy units have now embraced the National Bowel cancer Screening programme, providing additional services and high quality through the Global Rating Scale.
Increased service levels, and high demand for rapid investigation are focusing minds on efficient effective practice. In our departments we evaluate our practice and screening colonoscopy has been a recent area of analysis.
Methods We retrospectively interrogated endoscopy databases in two typical district general hospitals. We selected out colonoscopic investigations with a “family history of colorectal cancer” as the only indication. Data on age, polyp detection, cancer detection, and site were recorded. A sampling of approximately 10% of the notes was undertaken to understand the indication, and reason for colonoscopy.
These data were scrutinised against the gold standard British Society of Gastroenterology guidelines, and publications leading to this. Our population findings were compared using a χ2 statistic.
Results We analysed 298 colonoscopies, 49 patients (16%) had polyps detected, and 1 patient had a rectal cancer. Age ranged from 15 to 83 years old.
55 polyps were detected, 16 rectal, 23 sigmoid, 2 descending, 3 transverse, 6 ascending, and 5 caecal polyps.
Modelling population finding from the BSG guidelines, we would expect a polyp detection rate of 24%. Our findings demonstrate a significantly different outcome, and confirms our practice or population is significantly different from the populations informing the guidelines. (χ2 statistic 7.73, 1 degree of freedom, two tailed p=0.005).
Twenty-four referral letters were assessed as an indicative sample of criteria leading to colonoscopy. Only 11 (46%) documented family history consistent with strict adherence to BSG guidelines, suggesting at least our practices contribute to the differing outcomes (Abstract 077).
Conclusion Screening for a family history of bowel cancer detects significant numbers of adenomatous polyps and cancer at an earlier stage than symptomatic referral.
In our population pathology was found in 17%, significantly lower than the populations informing current BSG guidelines.
Strict adherence to BSG guidelines may reduce the colonoscopy workload by 33%, and free up 25 colonoscopy lists.
These finding across 2 separate hospitals may indicate a wider application in other regions.
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