Transcript (Draft) Pathway for Direct Access Flexible Sigmoidoscopy

Direct Access Flexible Sigmoidoscopy Pathway for GPs
Patients at any age
Patients 50+
LGI 4. Right lower abdominal mass consistent
with involvement of the large bowel.
LGI 1. Rectal bleeding with or without anal symptoms and no
change in bowel habit for 6 weeks or more.
LGI 5. Palpable rectal mass.
LGI 2. Rectal bleeding with change in bowel habit (increased
frequency/increased looseness) for 6 weeks or more.
LGI 3. Change in bowel habit for 6 weeks or more (increased
frequency/increased looseness) without rectal bleeding.
LGI 6. Unexplained iron deficiency anaemia
Men HB< 11g/dl
Post menopausal women < 10g/dl
Complete referral form and fax to Endoscopy Office at Croydon
University Hospital for Flexible Sigmoidoscopy within 24 hours
Fax Number: 020 8401 3855
Tel Number: 020 8401 3073
Referral to:
Cancer Services Office, Croydon University
Hospital for Colonoscopy
Fax Number: 020 8401 3337
Tel Number: 020 8401 3986
Provide Patient Information and Consent Form
Issue an enema prescription
Assess patient for self-administration. If inappropriate, Endoscopy Unit will
arrange District Nurse visit to administer to patient
• Hospital to contact patient by phone to arrange appointment
• Hospital arranges home enema with District Nurse (if required)
• Endoscopy appointment booked
• Letter sent to the patient
• Transport/interpreter arranged (if required)
Enema at home
Patient attends endoscopy appointment
Pre-assessment with consultant nurse endoscopist
Flexible sigmoidoscopy
Cancer Suspected
Enter colorectal pathway
Further investigations
Discuss at colorectal
MDT
Polyp detected
Adenoma
Hyperplastic
Book
Colonoscopy
Letter/report to GP
within 5 days with
outcome of consultation
Letter/report to GP within
5 days with outcome of
consultation
EXCLUSIONS
Patients with constipation
Significant co-morbidities (respiratory, cardiac, renal or neurological)
Patients who have had an endoscopic investigation (colonoscopy/flexible
sigmoidoscopy) within the last 2 years
Patients on anticoagulants especially for prosthetic heart valves and coronary stents
DNA
Cancer not suspected
Discharge back to GP
If referral to other speciality is
indicated, follow current trust policy
Advice and/or treatment may be
offered for haemorrhoids or minor
conditions
Letter/report to GP within 5
days with outcome of
consultation
Consultant Nurse Endoscopist to
write to the GP
Copied to the patient.
Offer another appointment
If patient DNAs 2nd appointment,
will be discharged back to their
GP
GP informed
Patients without mental capacity to consent
Patients who are already under investigation for suspected cancer
Patients with existing inflammatory bowel disease
Patients with known infective diarrhoea
Patients who will require an overnight stay