UK guidance advises Faecal Immunochemical Testing (FIT) should be used to triage all referrals for colonoscopy in patients presenting with lower gastrointestinal symptoms. We aimed to calculate the completeness and accuracy of FIT recording within endoscopy reports, and to evaluate whether endoscopist quality indicators were associated with FIT documentation.

All colonoscopies performed within an NHS Foundation Trust between 1 April and 31 May 2025 were reviewed. Procedures for lower gastrointestinal symptoms were identified, and FIT results recorded in endoscopy reports were compared with those in the local pathology system.

The completeness and accuracy of FIT recording were calculated. Endoscopists were grouped by annual procedure volume (<100 vs ≥100) and caecal intubation rate (<90% vs ≥90%), with associations analysed using chi-squared testing.

A total of 1,138 colonoscopies were performed over the 2-month period, of which 566 (49.7%) investigated lower gastrointestinal symptoms, performed by 37 endoscopists. Among these, 442 (78.1%) had a FIT result recorded on the endoscopy report, while a further 45 (10.2%) had a FIT performed but not recorded. Of the 442 reports with a recorded FIT, 425 (96.2%) were accurate; among the 17 (3.8%) inaccuracies, over half (n=9, 52.9%) involved minor numerical discrepancies (e.g. 40 recorded instead of 45).

Of the 37 endoscopists, 14 (37.8%) performed fewer than 100 colonoscopies annually, accounting for 88 procedures (15.5%), and 9 (24.3%) had a CIR <90%, performing 167 procedures (29.5%). There was no association between endoscopist annual

procedure volume and the completeness or accuracy of FIT recording (p = 0.79), nor between CIR and FIT recording (p = 0.07).

Most (88%) colonoscopies performed for lower gastrointestinal symptoms had a FIT completed prior to endoscopy; however, in 10% of cases, results were not included in the endoscopy report despite being available. FIT values recorded were accurate, and no association was found between FIT completion and endoscopist procedure volumes or CIR.

These findings highlight the need to improve processes surrounding FIT recording in symptomatic colonoscopy; ensuring all are triaged by FIT and that endoscopists can readily access and document results. This would support equitable and efficient utilisation of colonoscopy resources across the UK.