Which innovations can improve timeliness of investigations and address the backlog in endoscopy for patients with potential symptoms of upper and lower Gastrointestinal (GI) cancers?

How can we speed up investigations for patients with potential symptoms of cancers in the digestive system? 

Diagnosis of digestive system cancers uses endoscopy, which involves putting a flexible tube with a light and camera into the digestive system either through the back passage (rectum), or down the throat to the stomach, depending on the location of the cancer.  When the camera is used through the rectum to look at the lower bowel, this is called colonoscopy. 

The COVID-19 pandemic put severe pressure on the NHS and caused delays in cancer diagnosis.  For some patients this can have serious short and long-term consequences for their health and life expectancy. This review looks at evidence for new ways to tackle the waiting lists which have built up and ensure those at highest risk are seen first   It does not look at whether these new ideas improve clinical outcomes for patients. 

Key findings suggested that: 

• A new improved ‘poo’ test called FIT was able to help prioritise patients needing further testing using colonoscopy.   

• A test capsule swallowed by the patient could provide results which reduced the need for a colonoscopy. 

• Using an approach based on an individual’s risk factors could help to prioritise treatment for those with the greatest need. 

• Some new techniques had been used successfully at GP surgeries to assess patients with possible cancer symptoms. One example is a sponge which can help identify cancer in the muscular tube joining your throat to your stomach. 

Five of the 9 studies reviewed were of low to moderate quality.  

Suggested future actions: 

• Increase the use of FIT testing.  A low score for this test could reduce the numbers of patients being referred for further tests.  This could help reduce waiting lists and save NHS resources from being spent on unnecessary procedures. 

• Use the FIT test results to prioritise patients most in need of endoscopies for urgent cancer diagnosis. 

• Ensure that all areas of Wales have equal access to using FIT tests for this purpose. 

• Standardise guidelines for doctors and make sure they are followed throughout Wales. 

• Explore new techniques suitable for use in GPs surgeries to speed up time to diagnosis. 

• Streamline referrals so patients are referred directly by their GP to specialist investigations and cut out any interim steps. 

Read the full report