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 HB< 11g/dl Post menopausal women < 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-assessment with consultant nurse endoscopist Flexible sigmoidoscopy DNA Cancer Suspected Enter colorectal pathway Further investigations Discuss at colorectal MDT Consultant Nurse Endoscopist to write to the GP Copied to the patient. Polyp detected 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 Adenoma Hyperplastic Offer another appointment Book Colonoscopy Letter/report to GP within 5 days with outcome of consultation 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