TPW 1.07 A 1 year review of CT Colonoscopy Requests: Patient Demographics, Indications, and Diagnostic Outcomes

Abstract Aims In the UK 40,000 new colorectal cancers are diagnosed each year. Colonoscopy is considered to be the gold standard to diagnose colorectal cancers but CT colonoscopy (CTC) is being used increasingly. The aim of this study was to review CTC requests and highlight potential overuse in a regional health board consisting of district general hospitals. The outcome will inform a structured referral pathway to streamline the use of CTC to reduce pressures on the radiology service and improve patient care. Methods A retrospective review of all CTC carried out within the health board from January to December 2022. These requests were analysed for the outcomes of this study: indication, ASA grade, prior colonoscopy attempt, CTC findings and subsequent colonoscopy. Results A total of 421 CTC were performed. The age range was 25-93 (mean 72). Two-year mortality was 22% and 52% had an ASA of 3 or 4 which reflects a comorbid and frail population. 90% of CTC was requested by general surgeons. 60% did not have a colonoscopy attempted prior to scan. 68% had a positive QFIT. Colorectal cancer was identified in 4% of cases. 67% of scans were normal or simply showed diverticulosis. Conclusion Most CT colonoscopies were normal or showed diverticular disease, only a very small number identified colorectal cancer. The majority of patients did not have a colonoscopy attempted and most were ASA grade 3 or 4. This suggests we are over utilising a constrained diagnostic resource for patients who are not fit for further intervention.