Introduction
According to the NICE guidelines (2022) a two-week referral (TWR) for scopes is promoted for Unexplained Iron Deficiency Anaemia(IDA). Also, As per the BSG guidelines for the management of IDA in adults (BMJ 26 July 2021) Serum ferritin is the most useful marker of IDA. According to The joint guideline from ACPGBI and BSG (BMJ 12 July 2022), FIT is to be used to inform urgency of referral when found to have IDA. Hence, our objectives are:
1. Stratification of IDA referrals to Assess GP adherence to the national guidelines
2. Assess overall outcome of investigations in the patients referred as IDA
3. Assess sensitivity of IDA referrals combined with positive FIT for diagnosis of Lower GI cancers
Methods
Retrospective data collection from all TWR for lower GI scopes from January - June 2024 at Wigan, Wrightington and Leigh hospital. N= 342. Data was analysed using electronically maintained database (letters, UGI/LGI endoscopy and/or CT reports and blood results)
Results
1. ~ 30% referred patients Had true IDA
2. <2% patients had colorectal malignancy diagnosed
3. High concordance between low ferritin/HgB + a positive FIT result for Colorectal cancer diagnosis was noted
Conclusion
was an Increased number of incorrect TWR for IDA investigations by GPs. This added to Cost spiralling and bumping up endoscopy waiting times. Hence, we recommend that GP/ triage Nurse education is needed to cut-down unnecessary referrals and also Surgical registrars should look for investigations in last 2 years to decide on further investigations.
Authors
SHREYA SENGUPTA
Manchester, Manchester, United Kingdom
Violet Alavi
Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, United Kingdom