Faecal Calprotectin (FC) often helps clinicians to decide the need for colonoscopy in patient with variety of bowel symptoms. Many clinicians are uncomfortable with intermediately raised FC and tend to opt for colonoscopies to avoid the risk of missing an organic disease. The aim of this audit is to assess the influence the FC level on the rate colonoscopies and pathology found.Methods
Data were collected from Northampton General Hospital database for all FC specimens tested between April 2015 and March 2016. We excluded all IBD patients and patients aged 18 and under. We compared patients who had an intermediately raised FC (IRFC) results (51–150), patients with significantly raised FC (SRFC) results (≥151) and a selected manageable sample with negative FC (≤50).Results
2169 patients were tested for FC. 501 had raised FCs. 79 known IBD patients were excluded. The remaining were 217 patient with IRFC and 205 with SRFC. 111 of the FC negative group from August 2015 were studied.Results
Colonoscopies were done in 91 patients (42%) of the IRFC group, compared to 119 patients (58%) of SRFC. 24 patients (22%) with negative FC had colonoscopy.Results
Age and gender had no influence on the colonoscopy rate, but FC significantly influenced the rate of colonoscopy referral (χ2 test, p<0.0001).Results
96% of the patients scoped with FC ≤50 had normal colonic mucosa; one patient aged 66 had an adenoma. 78/91 (86%) patients with IRFC, had normal colons, 6 patients were newly diagnosed with IBD and 7 patients were found to have other colonic pathologies. This included 2 cancers seen in patients aged 42 and 55 who had weight loss or rectal bleeding. In the SRFC group, 70/121 (58%) had normal colons. 30 patients (25%) were newly diagnosed with IBD and 21 patients were found to have other colonic pathologies including 6 cancers.Conclusions
Faecal calprotectin significantly influences the rate of colonoscopy referral and outcome. There was good evidence to support colonoscopy in patients with FC >150, but 86% of patients had normal colons with FC of 51–150 and a repeat FC in the absence of warning symptoms would be reasonable, particularly in younger patients.