Direct Access Flexible Sigmoidoscopy Pathway for GPs

1
Direct Access Flexible Sigmoidoscopy Pathway for
GPs
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 Patients of any age LGI
4 Palpable rectal mass
2 Week Rule Colorectal Clinic LGI 5 Right lower
abdominal mass consistent with involvement of
the large bowel LGI 6 Unexplained iron deficiency
anaemia Men HBlt 11g/dl Post
menopausal women lt 10g/dl
Rapid Access Proctology Clinic 16-50 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 LGI 4 Palpable
rectal mass LGI 5 Right lower abdominal mass
consistent with involvement of the large
bowel LGI 6 Unexplained iron deficiency anaemia
Men HBlt 11g/dl Post menopausal women
lt 10g/dl
Referral to St Georges Healthcare NHS Trust Fax
Number 020 8725 0778 Tel Number 020 8725
1111 cancerreferraloffice_at_stgeorges.nhs.uk
Complete referral form and fax to St
Georges Healthcare NHS Trust within 24 hours
Fax Number 020 8725 0778 Tel Number 020 8725
1111 cancerreferraloffice_at_stgeorges.nhs.uk
Patient arrives at the Unit with a referral
letter from GP
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
• Confirmation sent to patient and GP
• Transport/interpreter arranged (if required)

Enema at home
Patient attends endoscopy appointment Pre-assessme
nt with nurse endoscopist Flexible sigmoidoscopy
DNA discharge back to GP
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
Book Colonoscopy
Letter to GP within 5 days with outcome of
consultation
Letter 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 FROM THE DIRECT ACCESS SIGMOIDOSCOPY
PATHWAY Patients with constipation Unexplained
iron deficiency anaemia Lower abdominal
mass Significant co-morbidities (respiratory,
cardiac, renal or neurological) Patients who have
had an endoscopic investigation
(colonoscopy/flexible sigmoidoscopy) within the
last 2 years