Cancer

Which colonoscopy triage guidelines perform best?


An evaluation of three sets of colonoscopy triage guidelines has found that Victorian guidelines perform most effectively and could help relieve pressure on endoscopy waiting lists.

When compared to national (Cancer Council/NHMRC) guidelines and the Optimum Cancer Care Pathway, the Victorian guidelines would reduce the proportion of referrals triaged as Category 1 by 10% without reducing cancer detection rates, a study has found.

Prof Jon Emery and colleagues at the Victorian Comprehensive Cancer Centre validated three sets of colonoscopy triage guidelines used in Australia by applying them to a reference dataset of 2,378 colonoscopies performed at Western Health, Melbourne between 2014 and 2016.

For each set of guidelines they calculated the number of colonoscopies that would be assigned to each triage category; the cancer detection rate (sensitivity) and the conversion rate (proportion of triage Category 1 colonoscopies that would diagnose a cancer).

The analysis found that both national and Victorian guidelines would reduce the proportion of Category 1 colonoscopies from the reference triage rate of 76.3% to 58.6% and 66.3%, respectively. The Optimal Cancer Care Pathway guidelines did not reduce the proportion of Category 1 colonoscopies (78.6%)

The Victorian guidelines were found to have the highest cancer detection rate (91.4%) and a conversion rate of 5.4%, whereas the national guidelines had a detection rate of 65.6% and a conversion rate of 4.4%. The Optimal Cancer Care Pathway had a detection rate of 80.6% and conversion rate of 4.0%.

The study investigators said their analysis showed that adoption of the Victorian guidelines would improve the performance of colonoscopy triage and help address excessive waiting times arising from the substantial increase demand in recent years.

They noted that the latest data from the National Bowel Cancer Screening Program showed a median time from positive FOBT result to colonoscopy in the public system of 84 days – and waiting times were often much longer for symptomatic patients in public hospitals

“If successfully implemented, [the Victorian guidelines] could significantly improve the triage process, reduce demand for urgent colonoscopies and potentially lead to more timely colorectal cancer diagnosis in Australian public hospitals,” they wrote.

However, to achieve this would require efforts to improve the quality of information in referral letters, because the Victorian triage categorisations include symptom duration. The categories also include a positive faecal occult blood test, and 5.8% of referrals would require an FOBT to inform the triage, the authors said.

The findings are published in Internal Medicine Journal.

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