Introduction Faecal calprotectin is a neutrophil derived protein that can be detected by quantitative enzyme linked immunosorbant assay in stool samples. It reliably predicts the level of mucosal inflammation in the lower gastrointestinal tract (1). The high negative predictive value of faecal calprotectin should lead to invasive investigation being avoided with a subsequent reduction in cost and demand on already stretched endoscopy services (2). We reviewed the use of faecal calprotectin in the trust to establish if current practise confirms this.
Methods The hospital numbers of all patients who had a faecal calprotectin processed at North Tees & Hartlepool NHS Foundation Trust from 01/04/2011 to 31/12/2011 were collected from the biochemistry department’s database. These patients’ case notes were then analysed to record the indication for faecal calprotectin, its result, subsequent investigation and management.
Results Faecal calprotectin was requested in 2 groups of patients: 68 with lower gastrointestinal symptoms and 44 with Inflammatory Bowel Disease (IBD). Of the 68 patients with lower gastrointestinal symptoms, faecal calprotectin was normal in 48 patients: 13 (9 males, 4 females, median age 30 years, commonest symptom abdominal pain) at initial presentation had no further investigation, 23 (11 males, 12 females, median age 41, commonest symptom abdominal pain) went onto have further investigations (12 colonoscopies, 3 flexible sigmoidoscopies and 1 small bowel meal and follow through; all normal); in 12(3 males, 9 females, median age 45, commonest symptom chronic diarrhoea) the negative faecal calprotectin was as a second line following initial investigation including 8 normal colonoscopies and 1 normal flexible sigmoidoscopy. Of those patients with IBD, faecal calprotectin was normal in 9 patients. In 7 patients management decisions were taken on the basis of its result alone. These included commencement of Infliximab (n = 2), 6-mercaptopurine (n = 1), azathoprine (n = 1), pentasa (n = 2) and prednisolone (n = 1) without further investigation.
Conclusion A negative faecal calprotectin led directly to the avoidance of a colonoscopy in 12 patients and of small bowel investigation in 11 patients. Given the trust’s current tariffs for faecal calprotectin, colonoscopy and small bowel meal and follow through, a total cost saving of £7,194.59 was made. Avoiding further investigation by waiting for a negative faecal calprotectin would have resulted in a greater cost saving.
Disclosure of Interest None Declared.
CA Lamb, JC Mansfield. Measurement of faecal calprotectin and lactoferrin in inflammatory bowel disease. Frontline Gastroenterol 2011; 2:13–18.
James Turvill. High negative predictive value of a normal faecal calprotectin in patients with symptomatic intestinal disease. Frontline Gastroenterol 2012; 3:21–28.
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