医学
介绍
急诊分诊台
恶性肿瘤
癌症
队列
结直肠癌
结肠镜检查
回顾性队列研究
内科学
儿科
急诊医学
普通外科
家庭医学
作者
Gaurav Nigam,Laween Meran,Ishita Bhatnagar,Sarah Evans,Reem Malik,Nicole Cianci,Julia Pakpoor,Charis Manganis,Brian Shine,Tim James,Brian D Nicholson,James E. East,Rebecca M Palmer
出处
期刊:Frontline Gastroenterology
[BMJ]
日期:2023-12-09
卷期号:: flgastro-102515
被引量:1
标识
DOI:10.1136/flgastro-2023-102515
摘要
Background Faecal immunochemical testing (FIT) is recommended by the National Institute for Health and Care Excellence to triage symptomatic primary care patients who have unexplained symptoms but do not meet the criteria for a suspected lower gastrointestinal cancer pathway. During the COVID-19 pandemic, FIT was used to triage patients referred with urgent 2-week wait (2ww) cancer referrals instead of a direct-to-test strategy. FIT-negative patients were assessed and safety netted in a FIT negative clinic. Methods We reviewed case notes for 622 patients referred on a 2ww pathway and seen in a FIT negative clinic between June 2020 and April 2021 in a tertiary care hospital. We collected information on demographics, indication for referral, dates for referral, clinic visit, investigations and long-term outcomes. Results The average age of the patients was 71.5 years with 54% female, and a median follow-up of 2.5 years. Indications for referrals included: anaemia (11%), iron deficiency (24%), weight loss (9%), bleeding per rectum (5%) and change in bowel habits (61%). Of the cases, 28% (95% CI 24% to 31%) had endoscopic (15%, 95% CI 12% to 18%) and/or radiological (20%, 95% CI 17% to 23%) investigations requested after clinic review, and among those investigated, malignancy rate was 1.7%, with rectosigmoid neuroendocrine tumour, oesophageal cancer and lung adenocarcinoma. Conclusion A FIT negative clinic provides a safety net for patients with unexplained symptoms but low risk of colorectal cancer. These real-world data demonstrate significantly reduced demand on endoscopy and radiology services for FIT-negative patients referred via the 2ww pathway.
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