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Consultant-led triage of 2ww referrals using specific vetting criteria in the era of covid-19 pandemic: Impact on the diagnostic yield for neoplasia and the backlog of endoscopy referrals and implications for the clinical practice
United European Gastroenterology Journal ; 9(SUPPL 8):892, 2021.
Article in English | EMBASE | ID: covidwho-1490999
ABSTRACT

Introduction:

Following the first Covid-19 outbreak in March 2020, national BSG guidance1 called for high quality triage of endoscopy referrals in order to balance the individual need for endoscopy against the limited service capacity. Accordingly, we developed specific vetting criteria, organized a consultant-led triage system and assessed its performance in the higher urgency 2-week-wait (2WW) referrals. Aims &

Methods:

Five consultants developed a triage algorithm which would provide coloured urgency (Green, Yellow and Red in order of decreasing urgency) and a respective time window (2-4, 4-8 and 8-12 weeks, respectively) to endoscopy referrals. Vetting criteria were based on national guidance and criteria (BSG and NICE) and were supplemented by European guidance2 where applicable.

Results:

A total of 401 2WW referrals (53.6% females, mean age 62.3 years) were received over a 3.5-month study period. The commonest indication was upper gastrointestinal symptoms (39%), followed by anemia (18.2%), lower GI symptoms (16.7%) and rectal bleeding (14.5%). In total, 20 cases of neoplasia were identified among 391 2WW endoscopies, leading to a diagnostic yield of 5.1%. Our triage system reduced the number of high-urgency referrals by 65.6%. The new high-urgency group (Green code) led to a diagnostic yield for neoplasia of 10.9%, i.e. more than double compared to that of the 2WW pathway. Expanding our high-urgency group to include the Yellow code referrals would identify all cases of neoplasia and would defer almost 50% of the 2WW referrals with no missed diagnoses of cancer. FIT (fecal immunochemical testing) values ≥ 100 μg/g (Green code) and 4 to 99.9 μg/g (Yellow code) led to a neoplasia diagnosis in 25% and 3.5%, respectively. No case of lower GI neoplasia had normal FIT value.

Conclusion:

Our triage algorithm was particularly effective and safe to use during the Covid-19 outbreak. It reduced significantly the number of high urgency endoscopy referrals, increased the diagnostic yield for neoplasia and deferred safely all referrals in the lower urgency, Red code priority group. Specific vetting criteria, such as the FIT value and Edinburgh Dysphagia Score have high negative predictive value and their use should be generalized given the pressure imposed on the diagnostic services and the weaknesses of the existing triage systems and criteria.

Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies / Prognostic study Language: English Journal: United European Gastroenterology Journal Year: 2021 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies / Prognostic study Language: English Journal: United European Gastroenterology Journal Year: 2021 Document Type: Article