Introduction Straight To Test (STT)services has been adopted by hospitals throughout the UK to improve the efficiency of pathways for early cancer diagnosis. Our previous results suggest that STT colonoscopies for suspected colorectal malignancy are feasible, safe and accurate1. There has been no studies however on the long term (5 years or greater) outcomes after a normal colonoscopy in these patients. It is unclear if it is safe to discharge them back to primary care. We aimed to look at the 5 year outcomes after a negative STT colonoscopy for patient s referred for suspected colorectal malignancy in 2007.
Methods In 2008 we conducted a retrospective study of all straight to test colonoscopies (Jan 2007 to Dec 2007) in Seacroft Hospital, Leeds1. Of the 195 colonoscopies (150 for rectal bleeding and change in bowel habits and 45 for iron deficiency anaemia), 104 were either normal or had insignificant findings and were discharged back to GPs without hospital follow-up. We looked at hospital records of all these patients in Dec 2012 (5 years after their index procedure) for further hospital contact, investigations or other diagnosis. Data was collected from the hospitals electronic patient record (patient pathway management system or PPM which records all secondary care hospital episodes in West Yorkshire) and the results server. All secondary care contacts and investigations by these patients would have been captured by PPM and results server.
Results Of the 104 included patients, we collected follow-up data on 96 (In 8 data could not be traced). 76 of these were never referred back to secondary care. 20 were referred back with various symptoms, 6 of whom had normal investigations, 9 had benign gastrointestinal disease and 5 developed cancers as detailed in table below.
Conclusion Only 1 patient developed colorectal malignancy on follow-up, but presented more than 5 years after the index colonoscopy with weight loss and but had a normal CT abdomen in the interim. 4 other had other malignancies with weight loss as the presenting feature in 50%. Patients who undergo STT colonoscopies for suspected colorectal malignancy can be discharged back to the GP with confidence by the endoscopist without follow-up in secondary care, but patients need to be warned to seek urgent help if losing weight.
Disclosure of Interest None Declared.
THE LEEDS EXPERIENCE OF THE STRAIGHT TO TEST PATHWAY F. A. Butt*(1), P. Mundre (2), G. G. Robins (2), M. Chadwick (2), M. E. Denyer (2), (1)(2)Gastroenterology, St James’s Hospital, Leeds, United Kingdom