Which innovations can improve timeliness of investigations and address the backlog in endoscopy for patients with potential symptoms of upper and lower Gastrointestinal (GI) cancers?

What is a Rapid Review? Our rapid reviews use a variation of the systematic review approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias. They follow the methodological recommendations and minimum standards for conducting and reporting rapid reviews, including a structured protocol, systematic search, screening, data extraction, critical appraisal, and evidence synthesis to answer a specific question and identify key research gaps. They take 1-2 months, depending on the breadth and complexity of the research topic/ question(s), extent of the evidence base, and type of analysis required for synthesis. Background / Aim of Rapid Review Many patients were not able to access routine diagnostic care through 2020/21 because of extraordinary pressures on the NHS due to COVID-19 and the UK national lockdowns. For some patients this can have serious short and long-term consequences to their health and life expectancy. The NHS has limited resources and is looking for new ways to meet many demands and patient needs. This Rapid Review Report aims to answer the question “Which innovations can be used to accelerate the patients’ journey through the endoscopic cancer diagnosis pathway?” The report highlights evidence of innovations and new ways to improve the timeliness of access to endoscopy and to address the backlog of unmet need for patients who have waited a long time for such tests and investigations by selecting those at highest for prioritisation. It does not evaluate in terms of effectiveness on clinical outcomes. Extent of the evidence base Recency of the evidence base Evidence of effectiveness Best quality evidence Policy Implications Strength of Evidence Review team and stakeholder involvement This Rapid Review is being conducted as part of the Wales COVID-19 Evidence Centre Work Programme. The above question was developed in consultation with Cancer Research UK’s identified research gaps and with Professor Tom Crosby OBE. Professor Crosby is a Consultant Oncologist, National Cancer Clinical Director for Wales and Clinical Lead for Transforming Cancer Services and acted as the expert stakeholder for this review. The search questions were identified as a priority during the Cancer/COVID-19 Research Summit hosted by Cancer Research UK (CRUK), Public Health England (PHE) and the National Cancer Research Institute (NCRI). The stakeholder group supporting the review work here is Cancer Research Wales. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Wales COVID-19 Evidence Centre (WCEC) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors * Acronym : Full Description 2WW : pathway 2-week-wait pathway ADR : Adenoma detection rate AEC : Ambulatory endoscopy centre CCE : procedure Colon capsule endoscopy procedure CRC : Colorectal Cancer CRUK : Cancer Research UK CT : colonography Computed Tomography colonography DES : Discrete Event Simulation FIT : Faecal immunochemical testing FS : Flexible Sigmoidoscopy GI : cancers Gastrointestinal cancers GP : General Practitioner JBI : Joanna Briggs Institute NCRI : National Cancer Research Institute NHS : National Health Service PHE : Public Health England PICO : framework Participant, Intervention, Comparison, Outcomes framework qFIT : Quantitative faecal immunochemical tests RCT : Randomised Controlled Trial RES : Rapid Evidence Summary STT : pathway Straight to Test pathway WCEC : Wales COVID-19 Evidence Centre