348 | wileyonlinelibrary.com/journal/apt Aliment Pharmacol Ther. 2019;50:348–372. © 2019 John Wiley & Sons Ltd Received: 25 February 2019 | First decision: 13 March 2019 | Accepted: 27 May 2019 DOI: 10.1111/apt.15378 Systematic review with meta‐analysis of over 90 000 patients. Does fast‐track review diagnose colorectal cancer earlier? Ella Mozdiak 1 | Yonas Weldeselassie 2 | Michael McFarlane 1 | Maria Tabuso 1 | Monika M. Widlak 1 | Amber Dunlop 1 | Alexander Tsertsvadze 2,3 | Ramesh P. Arasaradnam 1,2,4 As part of AP&T’s peer‐review process, a technical check of this meta‐analysis was performed by Dr Y Yuan. The Handling Editor for this article was Professor Colin Howden, and it was accepted for publication after full peer‐review. 1 University Hospitals Coventry and Warwickshire, Coventry, UK 2 The University of Warwick, Coventry, UK 3 Faculty of Health and Life Sciences, The University of Ottawa, Ottawa, ON, Canada 4 Centre for Applied Biological Sciences, Coventry University, Coventry, UK Correspondence Ella Mozdiak, University Hospitals Coventry and Warwickshire, Coventry, UK. Email: ella.mozdiak@nhs.net Summary Background: National UK data on colorectal cancer (CRC) stage at diagnosis is in‐ complete. Site‐specific fast‐track (2‐week wait) cancer data are not collected directly by NHS England. Policy making based on these data alone can lead to inaccuracy. Aims: To review available data on key outcomes (cancer conversion rate and stage at diagnosis) for the UK's lower gastrointestinal 2‐week wait pathway. Methods: A comprehensive literature search was conducted between 2000 and 2017. Primary outcomes were cancer conversion rate and cancer stage at diagnosis. Results were expressed as proportions with 95% CIs. A random effects model was used for meta‐analysis; heterogeneity was assessed by I 2 . Results: Of 95 papers reviewed, 49 were included in analysis with a total study popu‐ lation of 93,655. Cancer conversion rate was 7.7% (95% CI: 6.9‐8.5). The proportion presenting at Dukes A = 11.2% (95% CI 7.4‐15.6), B = 36.7% (95% CI 30.8‐42.8), C = 35.7% (95% CI: 30.8‐40.8) and D = 11.1% (95% CI 7.3‐15.5). No colonic pathology was diagnosed in 54.6% (95% CI: 46.2‐62.8). Conclusions: Only 7.7% of patients referred by the 2‐week wait pathway were found to have CRC. No beneficial effect on stage at diagnosis was found compared to non‐2‐week wait referral pathways. Over half of patients had no colonic pathology and detection of adenomas was very low. These results should prompt a reconsidera‐ tion of the benefits of the 2‐week wait pathway in CRC diagnosis and outcomes, with more focus on strategies to improve patient selection.