Direct Access Flexible Sigmoidoscopy Pathway for GPs

1
Direct Access Flexible Sigmoidoscopy Pathway for
GPs

• Patients at any age
• LGI 4. Right lower abdominal mass consistent
• with involvement of the large bowel.
• LGI 5. Palpable rectal mass.
• LGI 6. Unexplained iron deficiency anaemia
• Men HBlt 11g/dl
• Post menopausal women lt 10g/dl

• Patients 50
• LGI 1. Rectal bleeding with or without anal
  symptoms and no
• change in bowel habit for 6 weeks or
  more.
• 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.

Referral to Cancer Services Office, Croydon
University Hospital for Colonoscopy Fax
Number 020 8401 3337 Tel Number 020 8401 3986
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
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-assessme
nt with consultant nurse endoscopist Flexible
sigmoidoscopy
DNA
Consultant Nurse Endoscopist to write to the
GP Copied to the patient.
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
Polyp detected
Adenoma
Hyperplastic
Offer another appointment
Book Colonoscopy
If patient DNAs 2nd appointment, will be
discharged back to their GP GP informed
Letter/report to GP within 5 days with outcome of
consultation
Letter/report to GP within 5 days with outcome of
consultation
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
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