PTU-104 Lower gastrointestinal two week wait referrals: are they best managed by the gastroenterologist?

Introduction National Institute of Clinical Excellence guidelines recommend considering a cancer pathway referral for suspected lower gastrointestinal cancers via Lower Gastrointestinal two week wait pathway (LGI 2WW). Unexplained weight loss, abdominal pain, rectal bleeding, unexplained iron deficiency anaemia and a change in bowel habit are but a few indications. A third of bowel cancer cases in England are diagnosed via this referral route. In the majority, referred on the LGI 2WW, cancer is not final diagnosis. In the United Kingdom this is a pathway led by colorectal surgeons. We hypothesise the LGI 2WW pathway would be best led by the gastroenterologist in view of the non-cancer diagnosis made through the pathway. Method This was a retrospective, single centre case review series. One hundred consecutive patients referred via the LGI 2WW to our institution in the year 2016 were reviewed. Demographic data, investigations performed, endoscopy, final diagnosis made and follow up plan for patients were reviewed from Electronic Patient Records (EPR). Results Ninety-eight consecutive patients referred via the LGI 2WW pathway in the year 2016 were identified (n=98, M=47 and F=51; Mean age=66.5 years). Indication for referral and final diagnosis made has been summarised in the table below. Overall, no cause was identified in 39.8% (39/98) of individuals who were then discharged to their General Practitioner with no further investigations Conclusion In this study, out of 98 patients investigated via the LGI 2WW pathway, only one patient had evidence of a malignancy. A large proportion of patients referred to the service are discharge to the GP without a clear diagnosis. The majority of diagnosis found are non-surgical and managed usually within the UK by gastroenterologists. 3 patients in this study had a diagnosis of colitis and were not referred to GI physicians as per usual practice. Whilst urgent investigation to exclude colorectal cancer in suspected patients are imperative, we conclude that the referral pathway should be led by gastroenterologists rather than colorectal surgeons as the majority of diagnosis are managed by GI physicians.