Validation of Australian and Victorian guidelines for colonoscopy triage

Bowel cancer remains one of the most deadly cancers in Australia, however it is also one of the most manageable if detected early. Most bowel cancers are diagnosed when a person develops symptoms, such as diarrhoea or abdominal pain. People with these symptoms most often do not have bowel cancer but require investigation to rule it out. The demand for colonoscopies is increasing, mostly for people with bowel cancer symptoms, and with increased demand comes longer waiting times. This study from PC4’s Director, Jon Emery aimed to assess the diagnostic performance of National and Victorian colonoscopy triage guidelines and potential redistribution of triage priority categories. A dataset of 2,378 colonoscopies was used, with comparison with triage categorisation determined using the National Cancer Council Australia guidelines, Victorian triage guidelines and Optimal Cancer Care Pathways recommendations.
The results showed that the National and Victorian guidelines reduced the proportion of Category 1 colonoscopies compared with the reference triage. Victorian guidelines were associated with the highest detection rate. A higher proportion of unclassifiable colonoscopies was seen with the National guidelines compared to the Victorian ones. This suggests that systematically applying the Victorian guidelines could reduce the proportion of urgent colonoscopies by 10 per cent without reducing conversion or detection rates.

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