AimThe coronavirus pandemic has led to significant challenges for healthcare delivery across the globe. Non-emergency endoscopic activity in the UK has been postponed, raising concerns of increased delays in the diagnosis of colorectal cancer and a surge in demand once services resume. Measures to mitigate this risk must be considered.

Colonoscopy remains the 'gold standard' colonic investigation. It is the most commonly utilized method for investigating patients with symptoms suggestive of colorectal cancer. It facilitates both the diagnosis of, and therapy for, colorectal pathology [1]. Most colonoscopy is performed under sedation, but despite a drive to increase the quality of colonoscopy, 8%-20% of procedures will be incomplete and patients find the procedure uncomfortable [2][3][4]. The diagnostic yield of colonoscopy in the symptomatic population is low, with 46%-75%

Aim:The faecal immunochemical test (FIT) for faecal haemoglobin (f-Hb) helps determine the risk of colorectal cancer (CRC) and has been integrated into symptomatic referral pathways. 'Safety netting' advice includes considering referral for persistent symptoms, but no published data exists on repeated FITs. We aimed to examine the prevalence of serial FITs in primary care and CRC risk in these patients.Method: A multicentre, retrospective, observational study was conducted of patients with two or more consecutive f-Hb results within a year from three Scottish Health Boards which utilize FIT in primary care. Cancer registry data ensured identification of CRC cases.Results: Overall, 135 396 FIT results were reviewed, of which 12 359 were serial results reported within 12 months (9.1%), derived from 5761 patients. Of these, 42 (0.7%) were diagnosed with CRC. A total of 3487 (60.5%) patients had two f-Hb < 10 μg/g, 944 (16.4%) had f-Hb ≥ 10 μg/g followed by <10 μg/g, 704 (12.2%) f-Hb < 10 μg/g followed by ≥10 μg/g and 626 (10.9%) had two f-Hb ≥ 10 μg/g. The CRC rate in each group was 0.1%, 0.4%, 1.4% and 4.0%, respectively. Seven hundred and thirty four patients submitted more than two FITs within a year. The likelihood of one or more f-Hb ≥ 10 μg/g rose from 40.4% with two samples to 100% with six, while the CRC rate fell from 0.8% to 0%. Conclusion:Serial FITs within a year account for 9.1% of all results in our Boards. CRC prevalence amongst symptomatic patients with serial FIT is lower than in single-FIT cohorts. Performing two FITs within a year for patients with persistent symptoms effectively acts as a safety net, while performing more than two within this timeframe is unlikely to be beneficial.

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Background Colon capsule endoscopy (CCE) is a non-invasive alternative to colonoscopy. The reported sensitivity and specificity of CCE for the detection of clinically significant colonic neoplasia is high. To date, there have been no reported cases of colorectal cancer (CRC) missed by CCE which were located in segments adequately visualised by the capsule. Case presentation We present the case of a 71-year-old female, who underwent CCE for new lower gastrointestinal symptoms. The CCE reported 17 polyps (largest size 10 mm) and angiodysplasia. A 40 mm caecal pole tumour, not detected by the CCE, was identified at follow up colonoscopy. Surgical resection was performed, and the pathology sample was reported as moderately differentiated adenocarcinoma, pT2 pN0 (0/19) M0, with no evidence of EMVI. The patient made an uneventful recovery. The caecal pole tumour was not definitively identified on retrospective review of the CCE images. Conclusion To date, this is the first published case of a CRC missed entirely by CCE. Further research is required to allow calculation of the post CCE interval CRC rate to allow comparison with colonoscopy and CT colonogram.

Aims The COVID-19 pandemic has resulted in an unprecedented challenge. With the abolition of all non-urgent endoscopies nationwide, there has been concerning implications on colorectal cancer (CRC) diagnosis. Rationing of these scarce colonoscopy slots has become a priority. Faecal immunohistochemistry test (FIT) results are predictive of bowel pathology. Here we audit the clinical outcomes of patients that have undergone FIT in our health board in the pre and COVID-19 era. Methods Using business intelligence methods, an automated system for NHS eHealth data collection has been established. All patients who have undergone FIT testing are audited for clinical outcomes including investigation and pathology. Results from December 2018-2019 (pre-COVID) were compared to December 2019-January 2021 (COVID). Results There was a 70.12% increase in FIT uptake. 58.88% were female. Median age 73 (range 1-100). FIT results are compared below. Conclusion Our business intelligence approach has improved uptake of FIT in our community. There have been proportionally higher rates of colorectal cancer diagnosis with less resources. FIT specificity is 98.64% and therefore should be further widely accepted to ration resources.