Faecal immunochemical testing: introducing the service at NHS Tayside

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).