Purpose
Endoscopy
As an adjunct to clinical acumen, the 2022 Quantitative Faecal Immunochemical Test (qFIT) for Patients with Colorectal Symptoms: primary1 and secondary2 care guidance was published by Scottish Government to improve the prioritisation of patients with new lower gastrointestinal symptoms to lower endoscopy. Adherence with the existing guidance has been variable but the length of waits for investigation and the associated negative impact on patient outcome3 prompted the timing of this clinical consensus review.
On 1 March 2024, 153 delegates from across Scotland convened for the 4th National qFIT meeting to review the current evidence and available Scottish data.
The purpose of this document is to update the previous guidance into a single document, with best practice recommendations based on the evidence available, and expert consensus from primary and secondary care.
Local implementation and pathways
The pathways for qFIT testing need to be agreed at a local Health Board level including for timing of referral (i.e. with result, pending result or secondary care arranging qFIT), initial and repeat qFIT testing or managing symptomatic patients where no qFIT is received. Local procedures and implementation of the recommendations are not within the scope of this document.
Performance data
In 2023 the number of urgent suspicion of cancer (USC) referrals in Scotland had increased by 22.3% compared to 2019. The number of qFITs performed increased by 19.4% to over 219,000 tests. The number of colorectal cancer patients with an active or surveillance treatment plan increased by 6.5%.
For patients that are referred, colonoscopy or flexible sigmoidoscopy is often the first line of investigation. Despite an appropriate application of the Covid recovery guidance, in December 2023 only 44.1% of colonoscopy and 25.2% of flexible sigmoidoscopy were performed within 6 weeks of referral. 9.6% of patients waiting for a diagnostic colonoscopy and 19.2% of patients waiting for a diagnostic flexible sigmoidoscopy waited over 52 weeks, 2,325 patients in total.4
In addition, in March 2024, there were 8,377 patients more than 52 weeks overdue for a surveillance lower endoscopic procedure. Many of these individuals may be at higher risk for colorectal cancer than the new referrals [unpublished data from national endoscopy surveillance database April 2024].
Predominantly due to the endoscopic delays, colorectal cancer performance figures were lower than 2019 with 35.4% of care delivery not meeting the 62-day colorectal cancer standard.5