RESUMEN
In its 2015 NG12 guidance, NICE recommended the use of guaiac-based faecal occult blood test (gFOBT) and not FIT in primary care to triage patients with low-risk symptoms for cancer, due to paucity of evidence on FIT diagnostic accuracy at the time.1 But as evidence on FIT efficacy in symptomatic patients continued to emerge, gFOBT was replaced with FIT in NICE 2017 DG30 guidance.2 However, this recommendation was not extended to patients with high-risk symptoms for cancer or rectal bleeding.2 Since then, several pioneering centres in the UK, including centres in Nottingham, Oxfordshire and Tayside in Scotland, introduced FIT in patients with high and low risk symptoms using record linkage as part of service development projects, and reported promising results.3–5 At the same time, three large research studies were conducted in England, investigating the diagnostic accuracy of FIT in high and low risk symptomatic patients and reporting similar results.6–8 Two recent meta-analyses evaluated this and other evidence of the diagnostic accuracy of FIT.9,10 The key message from these studies remains remarkably consistent: The diagnostic accuracy of this test is, counter-intuitively, barely improved by the addition of other clinical characteristics into a risk-score.3,11Despite these encouraging results, there has been reluctance on the part of some groups in the UK, including NHS England, to recommend the use of FIT in the high-risk symptomatic patients because of concerns about missing cancer. Variation in post-colonoscopy colorectal cancer across colonoscopy providers in English National Health Service: population based cohort study.
RESUMEN
Faecal immunochemical testing (FIT) has a high sensitivity for the detection of colorectal cancer (CRC). In a symptomatic population FIT may identify those patients who require colorectal investigation with the highest priority. FIT offers considerable advantages over the use of symptoms alone, as an objective measure of risk with a vastly superior positive predictive value for CRC, while conversely identifying a truly low risk cohort of patients. The aim of this guideline was to provide a clear strategy for the use of FIT in the diagnostic pathway of people with signs or symptoms of a suspected diagnosis of CRC. The guideline was jointly developed by the Association of Coloproctology of Great Britain and Ireland/British Society of Gastroenterology, specifically by a 21-member multidisciplinary guideline development group (GDG). A systematic review of 13 535 publications was undertaken to develop 23 evidence and expert opinion-based recommendations for the triage of people with symptoms of a suspected CRC diagnosis in primary care. In order to achieve consensus among a broad group of key stakeholders, we completed an extended Delphi of the GDG, and also 61 other individuals across the UK and Ireland, including by members of the public, charities and primary and secondary care. Seventeen research recommendations were also prioritised to inform clinical management.
RESUMEN
Colorectal surgeons across the UK currently undertake a large proportion of routine diagnostic and therapeutic colonoscopy in most NHS Trusts [1]. Meanwhile, the new UK General Surgical curriculum now includes an indicative requirement of 200 diagnostic colonoscopies for surgical trainees who have declared a colorectal subspecialty interest (hereafter termed 'colorectal trainees'), indicating the JCST's (Joint Committee on Surgical Training) commitment to colonoscopy training. However, several studies have reported a marked deficiency in colonoscopy training opportunities and accreditation for surgical trainees compared with gastroenterology trainees [2-4].