P334 CT vs endoscopy: improving service efficiency by triaging endoscopy requests for ‘abnormal CT’

IntroductionEndoscopy services are experiencing significant pressure to meet targets for 2 week wait (2WW) and urgent colonoscopy requests, with a large proportion of requests being made following abnormal CT findings. This pilot study looks at the correlation between CT and endoscopic findings to determine whether we can downgrade the urgency of referrals whilst maintaining patient safety.MethodsA UniSoft search identified colonoscopies with indication ‘abnormal CT’. Following appropriate exclusions, we retrospectively reviewed 100 patients from March 2020 to February 2021 using electronic patient records.ResultsN=100. 69 urgent/2WW scans, 7 routine, 24 inpatients. Radiologists recommended endoscopy for 71 patients; 29 were requested by the referrer on CT review.25 normal colonoscopies. 75 pathological with varying degrees of severity, of which 45% did not require endoscopic intervention or further treatment.56 CT and endoscopic findings correlated. Excluding the rectum, left-sided CT abnormalities correlated better than right.44 CT abnormalities were considered incidental findings. These were less likely to correlate endoscopically (36%).53 had another indication for endoscopy: abdominal mass; anaemia; change in bowel habit; PR bleeding; weight loss; or FIT positive. This did not improve correlation: 57% with another indication showed CT and endoscopic correlation; 55% without.There was no significant difference when CT was reported by a Gastrointestinal (GI) radiologist. Reports by GI radiologists correlated in 48.4%; non-GI 59.4%.16 patients had colorectal cancer. of these, 14 CT reports recommended endoscopy. Where endoscopy was not mentioned, the report stated malignancy as the likely diagnosis. 14 CT reports explicitly mentioned malignancy. of the 2 that did not, malignancy was clearly implied.3 polyps showed high-grade dysplasia, all CT reports recommended endoscopic evaluation. of 11 incidental polyps, all showed low-grade dysplasia or hyperplastic polyps.ConclusionsThere were no unexpected findings of malignancy on endoscopy, all cases were identified on the CT report. This suggests that where malignancy is not radiologically evident, we can downgrade referrals from 2WW and maintain patient safety.We have introduced a triage of 2WW and urgent colonoscopy requests for ‘abnormal CT’, to downgrade referrals where appropriate and improve service efficiency. These cases will be followed up to ensure patient safety is maintained.We did not find a signi