title: Fast-track barium enema: meeting the two-week wait rule for patients with suspected colorectal cancer.
abstract: OBJECTIVE
  To meet the introduction of the two-week wait (TWW) rule for patients with suspected colorectal cancer, a fast-track barium enema (FTBE) service was set up. This study was conducted to evaluate the success of this approach in preparation for meeting the forthcoming targets on waiting times to treatment from referral and diagnosis.
  
  
  METHODS
  All patients were offered a double-contrast barium enema within two-weeks, except those with a palpable rectal mass. FTBE were double-reported by specialist gastrointestinal radiologists. Patients with a suspected malignancy were booked for an urgent staging CT and outpatient appointment, whilst the remaining patients were referred back to their general practitioner with a report. Prospective data were collected and two 16-month periods analysed.
  
  
  RESULTS
  Three hundred and nine patients had a FTBE over the first 16-month period and 277 (89.6%) were seen within two-weeks. Mean times from initial referral to staging CT and first outpatient appointment were 30.7 and 36.0 days, respectively. Cancer was confirmed histologically in 32 (10.4%) patients. Of 267 patients without a malignancy, 46 (17.2%) were referred back to the colorectal outpatient or endoscopy service within 6-months. The number of referrals increased with time from a mean of 19.3 per month in the first period to 27.8 in the second, but the percentage with a suspected malignancy remained similar at 13.6% and 10.1%, respectively.
  
  
  CONCLUSIONS
  FTBE diagnosed malignancy accurately and facilitated rapid staging. The TWW target was met in almost 90% of patients, whilst the impact on the colorectal outpatient and endoscopy service was minimized.
authors.affiliation: Department of Coloproctology, Bristol Royal Infirmary, Bristol, UK. damianglancy@doctors.org.uk
authors.forename: D G
authors.initials: DG
authors.lastname: Glancy
authors.forename: M
authors.initials: M
authors.lastname: Card
authors.forename: P A
authors.initials: PA
authors.lastname: Sylvester
authors.forename: M G
authors.initials: MG
authors.lastname: Thomas
authors.forename: P
authors.initials: P
authors.lastname: Durdey
authors.forename: M
authors.initials: M
authors.lastname: Callaway
authors.forename: J
authors.initials: J
authors.lastname: Virjee
mesh_terms: D000368:Aged; D001466:Barium Sulfate / Q000008:administration & dosage; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004733:Enema / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D009367:Neoplasm Staging / Q000379:methods; D010045:Outpatients; D011446:Prospective Studies; D012017:Referral and Consultation; D015203:Reproducibility of Results; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014850:Waiting Lists
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate