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PWE-342 Evaluation of fobt-positive individuals not undergoing colonoscopy in the bowel screening programme
  1. A Gemmell1,
  2. P Phull2
  1. 1University of Aberdeen Medical School
  2. 2Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen, UK


Introduction In the UK, population based colorectal cancer (CRC) screening is conducted based on biennial faecal occult blood testing (FOBT), with follow-up colonoscopy for positive results. However, a proportion of FOBT-positive subjects do not undergo colonoscopy, due to individual choice, comorbidity or current/recent colonic investigations for symptoms. The aim of this study was to evaluate this group of FOBT screen-positive subjects who do not undergo a screening colonoscopy.

Method Retrospective audit of prospectively collected data within the North East Scotland bowel screening database, between 1/06/2007 to 31/05/2013. Data was collected for reasons why colonoscopy was not performed, as well as the performance and results of further alternative imaging.

Results During the 6 year period of the audit, 4975 screening colonoscopy referrals were received for 4704 individuals (253 subjects had presented through 2 rounds and 18 through 3 rounds of the screening programme). Overall, 1081 (21.73%) referrals did not have a colonoscopy performed; 492 (45.5%) declined, a clinical decision was made in 525 (48.6%), 46 (4.3%) were under surveillance, 14 (1.3%) did not attend the appointment, 2 (0.01%) individuals died and no reason was identified in 2 cases.

Of the 492 subjects that declined colonoscopy, 36 (7.3%) had the procedure performed in the private sector, other reasons were recorded in 34 (6.9%) cases and no reason was recorded for the remaining subjects.

Of the 525 cases in whom a clinical decision was made not to perform colonoscopy, the reasons were recorded as significant co-morbidity in 159 (30.3%) with 25 (4.8%) cases of cancer, 151 (28.8%) subjects had colonic imaging within the previous 12 months, 26 (5%) had active IBD, 118 (22.5%) were in the symptomatic service with a colonoscopy appointment already arranged, 12 (2.3%) individuals had previous failed colonoscopies on >1 occasion, and other/no reason was recorded in 59 (11.2%) subjects.

Radiological colonic imaging (as an alternative to colonoscopy) was performed in 109 subjects: 38 CT colonography, 32 barium enema and 41 minimal-preparation CT scan abdomen/pelvis. Twelve cases of colorectal cancer were diagnosed in this group.

Conclusion The major reasons for screening colonoscopy not being performed are individuals declining or a clinical decision, with co-morbidity a major factor. Radiological imaging in selected cases has a significant yield for colorectal cancer.

Disclosure of interest None Declared.

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