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Faecal immunochemical testing: introducing the service at NHS Tayside

Faecal immunochemical testing is a fairly recent advance in the screening of patients for inflammatory bowel disease or colorectal cancer. Success in Scotland has shown that implementation of FIT can reduce the number of unnecessary colonoscopies, as Judith Strachan explains.

Gastroenterologists are increasingly challenged to provide an appropriate colonoscopy service to the population, with more referrals and longer waiting times. In Tayside, we had seen the number of colonoscopies going up year by year. However, the number of cancers identified was not changing, despite an increasing number of people being subjected to an invasive and potentially risky procedure.

 NHS Tayside has a longstanding history of bowel screening and also, more recently, of analysing faecal haemoglobin in samples from symptomatic patients. Based on concerns about increasing colonoscopy lists, we became involved in discussions with our gastroenterology team exploring the possibility of introducing quantitative faecal immunochemical testing (FIT) into our existing colorectal referral pathway. Could we triage people using a FIT result to refine whether they really needed a colonoscopy?

Data from our initial investigation was published in the journal Gut in 2016.1 General practitioners asked patients already being referred to gastroenterology to submit a faecal sample, so that we could analyse their faecal haemoglobin with FIT. This did not affect the patients’ subsequent management and progression along the standard gastro pathway. In retrospect, we then assessed clinical outcomes against the FIT result for each patient. This analysis showed that a negative FIT result correlated with a very low chance of having any significant bowel disease such as colorectal cancer or inflammatory bowel disease (IBD) (Fig 1).

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USCAP 113th Annual Meeting

Baltimore Convention Center, Baltimore, Maryland, USA
23-28 March, 2024

Pathology Horizons 2024

MacDonald Bath Spa Hotel, Bath
18-20 April, 2024

Diagnostics North East Conference 2024

The Catalyst, Newcastle upon Tyne
19 April, 2024

ECCMID 2024 - European Congress of Clinical Microbiology and Infectious Diseases

Fira Gran Via, 08038 Barcelona, Spain
27-30 April 2024

British Society for Microbial Technology Annual Microbiology Conference

UK Health Security Agency, Colindale, London
2 May 2024

EQA Reports: Interpreting Key Information & Troubleshooting Tips

ONLINE - Zoom
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Access the latest issue of Pathology In Practice on your mobile device together with an archive of back issues.

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