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Should We Do Lower GI Investigations for Melena after a Negative Endoscopy? - Analysis of 192 patients.

Mansoor Zafer 

NICE guidelines; Diagnostics Guidance (DG) 2.7 published 26 July 2017 suggests referral to secondary care for suspected cancer with positive Faecal Immunochemical testing (FIT) even when age and symptoms probability is low with Positive Predictive Value (PPV) ranging 0.1% to 3%. We attempted to do audit, to assess practice, with in and out-patient referrals to Gastroenterology department, referred with complaint of Melena or Rectal bleed towards Lower GI findings, to see if PPV fall within the range outlined by NICE DG 30.

 Methods: Retrospectively analysis of Endoscopy outcomes of patient who underwent Colonoscopy or CT-Colonoscopy from January 2017 to December 2017 at Conquest Hospital. Patients with complaint of melena or rectal bleed, who underwent Endoscopy (OGD), scored less than 8 as per Oakland Criteria were included. Patient scoring 8 or more on Oakland Criteria, with coagulation disorders were excluded. All analysis was done using Excel and JASP.

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