1579 Effect of COVID-19 pandemic on the Suspected Colorectal Cancer Pathway at a District General Hospital

Abstract

Abstract Aim During the initial phase of the COVID-19 pandemic the British Society of Gastroenterology and Joint Advisory Group on GI Endoscopy published guidance to halt all non-emergency endoscopy. As a result, CT was used as the first-line investigation with delayed completion endoscopy. We reviewed the efficacy of this change to determine its influence on future practice. Method All patients referred via the suspected colorectal cancer pathway (SCCP) to our district general hospital from 15/04/20-15/05/20 (during the initial COVID-19 lockdown) were included. Retrospective analysis of patient electronic records, radiology and endoscopy was performed. Results were analysed using χ² statistic. Significant incidental pathology was defined as non-colorectal pathology requiring referral to different speciality or further imaging. Results 115 patients were included for analysis, mean age 68 years. 2/115 (1.7%) were found to have a colorectal malignancy on CT, with no further diagnoses following completion colonoscopy. CT imaging detected significant incidental pathology in 31/115 (27%). Subgroup analysis by presenting complaint showed significant pathology was most likely to be detected in those presenting with weight loss (13/36, 36.1%, p = 0.049) or anaemia (12/31, 38.7% p = 0.084). Conclusions CT is a valuable first-line investigation in SCCP patients. In this cohort, no colorectal malignancies were missed on CT that were later detected on endoscopy and 27% of scans detected significant non-colorectal incidental pathology. Weight loss was found to have a statistically significant correlation with incidental pathology. These findings suggest CT as a possible first-line investigation in patients presenting with weight loss, anaemia or in the event of delayed access to endoscopy.