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Diagnostic yield from symptomatic lower gastrointestinal endoscopy in the UK: A British Society of Gastroenterology analysis using data from the National Endoscopy Database

Lookup NU author(s): Dr David Beaton, Professor Linda Sharp, Dr Liya Lu, Dr Matthew Rutter



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2024 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.Background: The value of lower gastrointestinal endoscopy (LGIE; colonoscopy or sigmoidoscopy) relates to its ability to detect clinically relevant findings, predominantly cancers, preneoplastic polyps or inflammatory bowel disease. There are concerns that many LGIEs are performed on low-risk patients with limited benefit. Aims: To determine the diagnostic outcomes of LGIE for common symptoms. Methods: We performed a cross-sectional study of diagnostic LGIE between March 2019 and February 2020 using the UK National Endoscopy Database. We used mixed-effects logistic regression models, incorporating random (endoscopist) and fixed (symptoms, patient age, and sex) effects upon two dependent variables (large polyp [≥10 mm] and cancer diagnosis). Adjusted positive predictive values (aPPVs) were calculated. Results: We analysed 384,510 LGIEs; 33.2% were performed on patients aged under 50 and 53.6% on women. Regarding colonoscopies, the unadjusted PPV for cancer was 1.5% (95% CI: 1.4–1.5); higher for men than women (1.9% vs. 1.1%, p < 0.01). The PPV for large polyps was 3.2% (95% CI: 3.1–3.2). The highest colonoscopy cancer aPPVs were in the over 50s (1.9%) and in those with rectal bleeding (2.5%) or anaemia (2.1%). Cancer aPPVs for other symptoms were <1% despite representing 54.3% of activity. In patients under 50, aPPVs were 0.4% for cancer and 1.6% for large polyps. Results were similar for sigmoidoscopy. Conclusions: Most colonoscopies were performed on patients with low-risk symptoms, where cancer risk was similar to the general population. Cancer and large polyp yield was highest in elderly patients with rectal bleeding or anaemia, although still fell short of FIT-based screening yields.

Publication metadata

Author(s): Beaton D, Sharp L, Lu L, Trudgill N, Thoufeeq M, Nicholson B, Rogers P, Docherty J, Jenkins A, Morris A, Rosch T, Rutter M

Publication type: Article

Publication status: Published

Journal: Alimentary Pharmacology and Therapeutics

Year: 2024

Pages: epub ahead of print

Online publication date: 18/04/2024

Acceptance date: 07/04/2024

Date deposited: 29/04/2024

ISSN (print): 0269-2813

ISSN (electronic): 1365-2036

Publisher: John Wiley and Sons Inc


DOI: 10.1111/apt.18003


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