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Original research
Prioritisation of lower gastrointestinal endoscopy during the COVID-19 pandemic: outcomes of a novel triage pathway
  1. Thomas Archer1,
  2. Imran Aziz2,
  3. Matthew Kurien2,
  4. Victoria Knott1,
  5. Alex Ball1
  1. 1 Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield, UK
  2. 2 Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Thomas Archer, Academic Department of Gastroenterology, Royal Hallamshire Hospital Department of Gastroenterology and Hepatology, Sheffield S10 2JF, UK; thomas.archer{at}


Objective The 2-week-wait (2ww) referral pathway is used in England to fast-track patients with suspected colorectal cancer (CRC). A two-stage triage pathway was used to prioritise lower gastrointestinal (LGI) endoscopy for suspected CRC during the COVID-19 pandemic.

Method All patients referred for an LGI endoscopy via a 2ww referral pathway between March 2020 and July 2020 were assessed. The first stage triaged patients to high, standard or low risk of CRC based on symptoms and faecal immunochemical test (FIT), and offered CT scans to those at high risk. The second stage, endoscopy prioritisation (EP), incorporated the CT results, FIT and symptoms to triage into four groups, EP1–EP4; with EP1 being the most urgent and EP4 the least. The primary outcome measure was CRC detection.

Results 514 patients were included. The risk of CRC was triaged as high in 190/514 patients (37%), standard in 274/514 patients (53%) and low in 50/514 (10%) patients. 422/514 patients (82%) underwent endoscopy with triage to EP1 in 52/422 (12%), EP2 in 105/422 (25%), EP3 in 210/422 (50%) and EP4 in 55/422 (13%). CRC was detected in 23 patients (5.4%). CRC was significantly more frequent in the EP1 group (23.1%, relative risk (RR)=16.2) and EP2 group (6.7%, RR=4.7) compared with EP3 group (1.4%). All CRC lesions were identified by CT imaging when performed prior to LGI endoscopy.

Conclusion This triage pathway designated 83% of patients with CRC to either EP1 or EP2. During a period of limited endoscopy provision, this pathway effectively prioritises endoscopy for those at greatest risk of CRC.

  • endoscopy
  • COVID-19

Data availability statement

Data are available upon reasonable request. Anonymised data from the study can be requested from the author by emailing

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Data availability statement

Data are available upon reasonable request. Anonymised data from the study can be requested from the author by emailing

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  • Contributors TA: data curation, formal analysis, investigation, project administration and writing. IA, MK and VK: data curation, investigation and writing. AB: conceptualisation, formal analysis, investigation, project administration and writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.