Nottingham Colorectal Service, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Division of Epidemiology and Public Health, School of Community Health Sciences, University of Nottingham, Nottingham, UK.
Colorectal Dis. 2017 Sep;19(9):819-826. doi: 10.1111/codi.13667.
We have introduced 'straight-to-test' (STT) colonoscopy as part of our 2-week-wait (2WW) pathway to address increasing numbers of urgent referrals for colorectal cancer (CRC) within the National Health Service. In this study we evaluated the ability of this initiative to shorten the time to diagnosis of CRC.
We amended our 2WW referral form to include performance status and comorbidities. General practitioners were asked to provide data on estimated glomerular filtration rate and full blood count/ferritin. Our 2WW referrals were screened by a colorectal consultant and a nurse specialist. Those deemed unsuitable for STT were offered outpatient assessment (OPA).
Of 553 2WW referrals screened, 352 were considered suitable, 65 of whom failed a telephone assessment or were uncontactable, and accordingly 287 were offered the STT pathway. The STT group was significantly younger than the OPA group (median 65.9 years vs 78.7 years; P < 0.0001). STT colonoscopy significantly reduced the time to first test (13 days vs 22 days; P < 0.0001) and tissue diagnosis from the referral date (17 days vs 24.5 days; P < 0.0001). Thirty-seven (6.8%) CRCs were detected. Proportionately fewer patients in the STT pathway were managed with 'best supportive care only' compared with patients attending OPA (one of 15 vs six of 22, respectively). STT colonoscopy obviated the need for clinic attendance before testing in 287 patients, representing a potential net cost benefit of at least £48 500 in 4 months.
STT colonoscopy was safe and effective for selecting out a group of symptomatic patients who could proceed straight to endoscopic examination and receive a diagnosis more rapidly.
我们引入了“直接检查”（STT）结肠镜检查作为我们 2 周等待（2WW）途径的一部分，以解决国民保健制度中越来越多的结直肠癌（CRC）紧急转诊问题。在这项研究中，我们评估了这一举措缩短 CRC 诊断时间的能力。
我们修改了我们的 2WW 转诊表，以包括绩效状态和合并症。全科医生被要求提供估计肾小球滤过率和全血计数/铁蛋白的数据。我们的 2WW 转诊由一名结直肠顾问和一名护士专家进行筛查。那些被认为不适合 STT 的人被提供门诊评估（OPA）。
在筛查的 553 例 2WW 转诊中，352 例被认为适合，其中 65 例电话评估失败或无法联系，因此 287 例被提供 STT 途径。STT 组明显比 OPA 组年轻（中位数 65.9 岁 vs 78.7 岁；P<0.0001）。STT 结肠镜检查显著缩短了首次检查的时间（13 天 vs 22 天；P<0.0001）和从转诊日期到组织诊断的时间（17 天 vs 24.5 天；P<0.0001）。发现 37 例（6.8%）CRC。STT 途径中接受“仅最佳支持治疗”的患者比例明显低于接受 OPA 的患者（分别为 15 例中的 1 例和 22 例中的 6 例）。STT 结肠镜检查避免了 287 例患者在检查前进行诊所就诊的需要，这在 4 个月内至少带来了 48500 英镑的净成本效益。
STT 结肠镜检查对于选择一组可以直接进行内镜检查并更快获得诊断的有症状患者是安全有效的。
