Introduction NICE guidelines recommend the use of faecal calprotectin (FC) in the differential diagnosis of inflammatory bowel disease and irritable bowel syndrome.¹

It has been shown that introduction of FC testing reduces endoscopy demand by up to 67%.²

As part of a NICE Health Technology Adoption study we looked at the use of FC across Wandsworth CCG and subsequent rates of lower GI endoscopies. We also looked at the impact of FC testing on lower GI endoscopies in secondary care.

Method We carried out a retrospective review of gastroenterology clinics at St George’s Hospital, recording FC results and the numbers of lower GI endoscopies carried out in patients aged 16–40 with lower GI symptoms but no red flag symptoms.

We then analysed the endoscopy database from our centre for the 8 months following the introduction of FC testing in primary care and 8 months prior to introduction.

ResultsFC testing was requested on 538 patients (328 females 210 males). Results were available from 519 patients.

If endoscopy was performed in all patients before availability of FC then FC testing led to a reduction in lower endoscopies of 48% (269 vs. 519). If lower GI endoscopy was limited to those with an abnormal FC (183) there would be a 65% reduction.

Between 1/4/13 and 30/11/13 3,247 lower gastrointestinal endoscopies were performed. in the age range 16–40 541 procedures were carried out (236 colonoscopies, 305 flexible sigmoidoscopies).

Between 1/4/14 and 30/11/14 3,556 lower gastrointestinal endoscopies were performed. in the age range 16–40 756 procedures were carried out (330 colonoscopies, 426 flexible sigmoidoscopies).

Conclusion We have shown that in secondary care clinic, the use of FC reduced the rate of lower GI endoscopies by 65%, in line with previous work.²

In the 8 months since the introduction of FC testing in primary care there was no reduction in lower gastrointestinal endoscopies. Possible reasons for this: St George’s hospital serves more than 1 CCG and FC testing uptake has predominantly been via 1 CCG, the year on year growth in lower GI referrals may be greater than the reduction in referrals following FC testing, or FC testing may not reduce referrals. More detailed analysis of the impact of FC testing is required.

Disclosure of interest None Declared.

References

1. Faecal Calprotectin diagnostic tests for inflammatory diseases of the bowel. NICE diagnostics guidance Oct 2013

2. Van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ 2010;341:c3369