ASSESSING THE APPROPRIATENESS OF COLONOSCOPY REFERRALS AND POST COLONOSCOPY FOLLOW UP IN A SINGLE CENTRE

Aims:

The volume of referrals for colonoscopy procedures is increasing exponentially and currently healthcare systems are under extreme pressure to meet this demand. Frequently questions are raised regarding the appropriateness of referrals for these invasive procedures. There were three primary aims of this study; firstly to assess if colonoscopy referrals were appropriate, secondly to investigate if surveillance endoscopies were following guidelines and lastly to detect whether pathological findings were found for those referred with ‘red flag’ symptoms.

Methods:

During a six month period in 2017, a single consultant surgeon completed 531 colonoscopies at a large healthcare facility in the west of Ireland. Data collected on patients included gender, age, reason for referral or follow up, anti coagulant/anti platelet medication, ability to complete endoscopy and colonoscopy outcomes.

Results:

In total there were 63 (11.8%) surveillance colonoscopies for cancer, IBD and polyps. All of these adhered to the NICE guidelines and British Society of Gastroenterology follow up protocols.

There were 468 referrals for colonoscopies. The most common reasons were PR bleeding (19.8%), abdominal pain (19.8%) & change in bowel habit (16.2%). In total 66% of indications were deemed clearly appropriate, 19% were uncertain in the absence of more detailed information and 15% were clearly inappropriate.

In total, there was a low pathological yield, 46.1% were completely normal. Including diverticulosis, fissures and haemorrhoids as benign conditions, the figure for non pathological findings rose to 80.4%. Three colon cancers were detected in total. Red flag symptoms of weight loss, anemia, change in bowel habit and PR bleeding did not detect significant rates of disease.

Conclusions:

More detailed referrals including clinical examination findings are necessary to stratify patients more efficiently into risk categories so that those with cancer are reviewed and scoped promptly.