BACKGROUND: NICE guidelines; Diagnostics Guidance (DG) 2.7 published 26 July 2017 suggests referral to secondary care for suspected cancer with positive Faecal Immunochemical testing (FIT) even when age and symptoms probability is low with Positive Predictive Value (PPV) ranging 0.1% to 3%.
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We attempted to do audit, to assess practice, with in and out-patient referrals to Gastroenterology department, referred with complaint of Melena or Rectal bleed towards Lower GI findings, to see if PPV fall within the range outlined by NICE DG 30. |
METHODS: Retrospectively analysis of Endoscopy outcomes of patient who underwent Colonoscopy or CT-Colonoscopy from January 2017 to December 2017 at Conquest Hospital. Patients with complaint of melena or rectal bleed, who underwent Endoscopy (OGD), scored less than 8 as per Oakland Criteria were included. Patient scoring 8 or more on Oakland Criteria, with coagulation disorders were excluded. All analysis was done using Excel and JASP.
RESULTS: We categorised the data as group one; moderate to severe AND group two; mild severity, and analysed cumulative. Among group one we found, 3 patients with distal bowel cancer (1.56%), 2 with Angiodysplasia (1.04%), 2 with multiple oedematous polyps (1.04%), 1 with pseudo-membranous colitis (0.52%), 1 with distal colitis (0.52%). The group two, included 2 patients with single polyps (1.04%), 3 with milder diverticular disease (1.56%), 2 with haemorrhoids (1.04%), and 2 with Anal fissure (1.04%). Cumulative Upper GI findings in 91/192 (47.33 %), Lower GI findings in 101/192 (52.60 %). Chi Square test 4.88 with p <0.02. Prevalence 13.02%. OR of 1.11, 6.71 The PPV of 9.375% (higher as outlined by NICE guideline July 2017 for 0.1% to 3%).
DISCUSSION: Retrospective root cause analysis via audit for outcome of Colonoscopy or CT-Colonography has significant advantages in diagnosing lower GI pathology. It provides basis for targeted educational programs to improve detection of lower GI pathology.
Key Words: Melena, Gastro-Intestinal (GI), Colonoscopy, CT-Colonography. Positive Predictive Value (PPV), Odds Ratio (OR).
