{
  "abstract": "Introduction This study aimed to evaluate the appropriateness of referring patients under 40 years for twoweekwait (2WW) colonoscopy based solely on a positive faecal immunochemical test (FIT). The growing use of FIT in younger adults has placed increasing pressure on endoscopy services. Previous studies, including Barlow et al, 1 have highlighted the low positive predictive value of FIT in this age group, reporting a PPV of 0.4% for patients under 29 years. Overall, FIT thresholds >10 µg Hb/g are considered of limited value for colorectal cancer (CRC) detection in individuals younger than 40 years.Methods A retrospective audit was conducted using the Solus endoscopy database and eCare records at Milton Keynes University Hospital. All patients under 40 years who underwent colonoscopy between 1 November 2024 and 31 October 2025 were included. Data collected included demographics, referral pathway, endoscopic findings, and histopathology results, which were analysed using an Excel dataset.Results A total of 196 colonoscopies were performed in patients under 40, of whom 124 (63%) were female. Of these, 96 procedures were triaged as 2WW referrals; 35 (36.5%) of these were male. Seventeen patients were referred via an urgent noncancer pathway, while 83 were categorised as routine. The minimum age was 19 years, with a mean of 32 years.The most frequent diagnosis among the 2WW cohort was colitis/ileitis (28/96; 29%), followed by haemorrhoids (24/96; 25%) and polyps (17/96; 18%). Only one patient had a polyp exhibiting predominantly lowgrade dysplasia with areas transitioning to highgrade dysplasia and possible adenocarcinoma; a second pathology review is pending.Among the 11 patients with concurrent iron deficiency undergoing 2WW colonoscopy, 6 had colitis/ileitis and 2 had polyps. One patient was subsequently diagnosed with coeliac disease.Conclusion Colitis/ileitis represented the most common finding in this population, followed by haemorrhoids and polyps. Only one case demonstrated concerning dysplastic changes, highlighting the limited diagnostic yield of 2WW referrals based solely on FIT positivity in patients under 40. These findings suggest that incorporating additional indicators—such as iron deficiency or elevated faecal calprotectin—may improve triage accuracy. Many FITpositive patients in this age group could potentially be managed through urgent or routine pathways rather than the 2WW route, particularly when presenting with isolated rectal bleeding.Reference Barlow M, Messenger D, Preece R, Prowse A, Abel G, Hamilton W et al. The diagnostic accuracy of the faecal immunochemical test for the detection of early-onset colorectal cancer: an age-stratified analysis in South West England. Br J Cancer. 2025;133(8):1170–1177. doi: 10.1038/s41416-025-03154 7. Epub 2025 Aug 22",
  "authors": [
    {
      "affiliations": [
        "Milton Keynes University Hospital, Milton Keynes, United Kingdom"
      ],
      "name": "Aisha Nazeer"
    },
    {
      "affiliations": [
        "University of Buckingham Medical School, Milton Keynes, United Kingdom"
      ],
      "name": "Sze Kit Byron Ng"
    },
    {
      "affiliations": [
        "Milton Keynes University Hospital, Milton Keynes, United Kingdom"
      ],
      "name": "Fatma Elsayed"
    },
    {
      "affiliations": [
        "Milton Keynes University Hospital, Milton Keynes, United Kingdom"
      ],
      "name": "Tracy Wothers"
    },
    {
      "affiliations": [
        "Milton Keynes University Hospital, Milton Keynes, United Kingdom"
      ],
      "name": "Nathalie Tihon"
    },
    {
      "affiliations": [
        "Milton Keynes University Hospital, Milton Keynes, United Kingdom"
      ],
      "name": "Ravi Madhotra"
    }
  ],
  "title": "P332 Assessing the appropriateness and outcomes of 2WW colonoscopy referrals for FIT positive patients under 40 years age: a DGH experience",
  "uid": "3fc8eca3-2566-567e-8d6b-53ad2e8c9f05"
}