Key changes

Endoscopy

The indication for qFIT are more clearly defined. The indications include new:

  • Repeated anorectal bleeding without an obvious anal cause.
  • Blood mixed through the stool.
  • ≥ 4 weeks change in bowel habit, particularly looser or more frequent stool.
  • Iron deficiency anaemia (haemoglobin below reference range and ferritin < 30mg/l or confirmed on iron studies).
  • Persistent Abdominal Pain (>4 weeks) and Weight loss (>5%).

qFIT is not indicated for the investigation of:

  • A rectal or abdominal mass or unexplained anal ulceration. These should be referred as USC.
  • Weight loss (>5%) without one of the qFIT indications above.
  • Abdominal pain without other concerning symptoms.
  • Thrombocytosis in the absence of persistent (>4 weeks) lower GI symptoms.
  • Haemorrhoids, anal fissures or warts in absence of other concerning symptoms.
  • Family history of colorectal cancer, polyps or a genetic condition that predisposes to colorectal cancer.
  • Acute symptoms such as a clinical episode of gastroenteritis or diverticulitis.
  • Long-standing symptoms such as constipation, bloating or abdominal pain.

Or as a screening test out-with the bowel screening programme.

 

Testing and referral guidance

The threshold for USC priority has increased from 10 to 20µgHb/g faeces (see qFIT lower gastrointestinal investigation priority based on qFIT result and qFIT threshold for USC referral for the impact of these changes) 

All patients with unexplained new iron deficiency anaemia should undergo a second qFIT within 6 weeks, if the first is <20µgHb/g faeces. If the second qFIT is ≥20µgHb/g faeces, the patient should be referred as USC for lower gastrointestinal investigations. If the second qFIT is <20µgHb/g faeces the patient can be referred as non-USC (see Lower gastrointestinal investigation priority based on qFIT result).  

For all other patients, where the first qFIT was <20µgHb/g faeces, a second qFIT should be performed if the patient has persistent lower gastrointestinal symptoms causing clinical concern or support is required for symptom management. If the second qFIT is ≥µgHb/g faeces the patient should be referred as USC for lower gastrointestinal investigations.

If a patient has two qFIT’s <20µgHb/g faeces, secondary care referral can still be made on a non-USC pathway if there are ongoing concerning symptoms.

 

Secondary care consensus:

Patients with new unexplained iron deficiency anaemia should be prioritised for lower gastrointestinal investigation using the qFIT results. Patients with one or more qFIT≥20µgHb/gfaeces should be triaged as USC. Patients with one or more qFITs 10-19µgHb/g faeces can be triaged as Urgent.

Patients with both qFIT results <10µgHb/g faeces can be considered for routine lower gastrointestinal investigation if there is ongoing clinical concern.

 

Unchanged

A rectal and abdominal examination should be performed prior to requesting a qFIT. Haemoglobin, ferritin or iron studies, and renal function are also advised.

The qFIT result should guide the priority of secondary care referral and investigation.

Patients who are unable to complete a qFIT where indicated should still be referred as USC. The reason for the qFIT not being completed should be provided in the referral.