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The Use of Radiology in Bowel Screening Wales: 3 Years Data
Chris Brown*2, Mark Robinson1, Gethin Williams1
1General Surgery, Colorectal & Radiology Departments, Newport, United Kingdom; 2General Surgery, Gwent Institute for Minimal Access Surgery, Newport, United Kingdom
Introduction: Colonoscopy is the gold standard diagnostic screening test used by Bowel Screening Wales (BSW). However, when a patient returning a positive faecal occult blood (FOB) test is deemed to be too high risk for colonoscopy, radiological imaging at the screening colonoscopist's discretion is offered as an alternative.
Aim: Assessment of the use of substitutive radiological imaging by BSW
Methods: Data was collected retrospectively from the BSW database in one Health Board between 2009 and 2012. All patients who were referred directly for CT colonogram (CTC) or CT abdomen & pelvis (CTAP) following initial assessment and those subsequently referred following a failed or incomplete colonoscopy were identified. Factors assessed included demographics, co-morbidity and reasons for radiological imaging over colonoscopy, colonic findings and estimated sensitivity of CTC.
Results: 93.6% (n=1687) patients underwent colonoscopy. 6.4% (n=108, 63 Male, 53 Female) of all patients returning positive FOB were referred for substitutive radiological imaging. 94% underwent CTC and 6% CTAP (median age 66 and 70 years respectively). 82% of patients were referred directly following initial assessment with the remaining 18% following incomplete endoscopy. Median time from referral to study report was 5 weeks. Frequently stated reasons for imaging were history of significant cardiovascular disease, history of failed endoscopy, warfarin therapy and poor mobility. 39% of scan reports documented potentially significant pathology, 74% (n=30) of which were colonic polyps (28% >10mm), 10% (n=4) tumours and 13% (n=5) bowel wall thickening or stricture. Subsequent referral for endoscopic investigation revealed an estimated sensitivity of CTC for identification of potential colonic neoplasm in the region of 80%.
Conclusion: CTC is a rational alternative imaging modality for further investigation of positive FOB in those patients deemed unfit for colonoscopy. A surprisingly high number (6.4%) of screening patients undergo radiological imaging; this has obvious resource implications for Radiology Departments.
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