Introduction The demand for colonoscopy is ever increasing, with greater pressures on endoscopy units. In order to provide a more efficient and timely service we conducted a review of our practice. Our aim was to audit colorectal cancer screening and surveillance colonoscopy procedures and determine the impact of the updated BSG guidelines (2010) on service provision.1
Methods The clinical letters, pathology reports and previous endoscopy reports were reviewed for all patients scheduled for surveillance colonoscopy over a period of 3 years (2010–2012). Data gathered included patient demographics, indication for procedure and outcome when audited against the current BSG guidelines. If the procedure did not meet the current guidelines with respect to indication or timing, the responsible clinician contacted both patient and GP, offering a clinic appointment to discuss further if needed.
Results A total of 354 colonoscopy requests were reviewed. Median age of the group was 62 years (range 22–98 years), male to female ratio 1.7:1. Indications included polyp surveillance 214 (60%), IBD surveillance 55 (15%), family history of colon cancer 50 (14%), high-risk disease and family groups 17 (5%), previous colon cancer 9 (3%) and other indications 9 (3%). 152 (43%) were appropriate when audited against the current guidelines with no changes made to their procedures. Of the remaining 202, 106 (52%) had the time to follow-up procedure extended (mean 3.25 years), 73 (37%) did not meet the criteria for a repeat procedure and 23 (11%) procedures were inappropriately delayed (mean 1.30 yrs). 125 colonoscopy requests were relevant to the updated guidelines for IBD surveillance, family history of colon cancer and high-risk disease and family groups. There were 57 IBD surveillance requests, of which 24 (42%) had the time to follow-up procedure extended (mean 1.75 yrs). Out of 51 requests with family history of colorectal cancer, 23 (45%) had the time to scheduled screening procedure extended (mean 8 yrs).
Conclusion Evaluating existing colonoscopy referrals against up to date BSG guidelines will contribute towards providing a more efficient colonoscopy service. In our practice a fifth of patients on the waiting list were inappropriate for further surveillance and a further third had the time to their procedure extended, therefore increasing capacity and efficiency to allow timely deliverance of procedures for those needing surveillance.
Competing interests None declared.
Reference 1. Cairns S, et al. Gut 2010;59:666–90.
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