Direct Access Flexible Sigmoidoscopy - PowerPoint PPT Presentation

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Direct Access Flexible Sigmoidoscopy

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  1. Direct Access Flexible Sigmoidoscopy Mr Sanjay Wijeyekoon – Consultant Colorectal Surgeon Dr Rob Palmer – GPwSI Gastroenterology

  2. Direct Access Flexible Sigmoidoscopy • A diagnostic service for GPs to assist them with the management of patients under the age of 55yrs presenting to primary care with rectal bleeding.

  3. History & Examination

  4. 2 week wait referral criteria • All ages • Definite, palpable, right sided, abdominalmass • Definite, palpable, rectal (not pelvic) mass • Unexplained iron deficiency anaemia • AND: [ ] Male with a Hb of < 11g/dl [ ] Non menstruating female with a Hb of < 10g/dl • Over 40 years • Rectal bleeding WITH a change of bowel habit towards looser stools &/or increased frequency  6 wks • Over 60 years • Rectal bleeding persisting  6wks WITHOUT a change in bowel habit or anal symptoms (e.g. soreness, discomfort, itching, prolapse, pain) • Change in bowel habit to looser stools &/or more frequent stoolspersisting  6 wks WITHOUT rectal bleeding

  5. Routine Referral to Secondary Care • No red flag sx, but other GI symptoms - Abdominal pain - Weight loss - Normocytic anaemia - Previous colonic polyps - Past history IBD - Strong FH CRC • Age >55yrs (not meeting 2ww criteria)

  6. Direct Access Flexible Sigmoidoscopy If age <55 and no colonic sx: • Treat pathology • Monitor Consider referral if: • Symptoms persist >4w • Symptoms recur • ?If no perianal pathology found • Patient anxious

  7. Referral for DAFS • Choose and Book • Under Diagnostic Endoscopy • Directly bookable appointment • Appointments available on Monday afternoons • Complete referral form and send electronically with CAB • Give patient information leaflet to patient

  8. Information for patients - medications • Aspirin & Clopidogrel: • Continue • No contraindication to diagnostic procedure +/- biopsies on aspirin or clopidogrel • Warfarin: • Continue • GP to check INR 1 week before endoscopy date • If INR within therapeutic range, continue usual daily dose • If INR above therapeutic range but <5, reduce daily dose until INR returns to therapeutic range • Iron tablets: • Stop 1 week before procedure

  9. Information for patients – the procedure • Bowel prep • Consent • Procedure • Advocacy / Transport

  10. Unsuitable Patients • Acute anal pain suggestive of anal fissure (procedure unlikely to be tolerated) • Recent MI or CVA within 6w • Obesity (overall weight >135kg) • Dementia • Poor mobility (need to be able to transfer from chair to bed)

  11. Follow-up • All patients will be discharged back to primary care following this procedure unless diagnosis of serious pathology found: • malignancy • IBD • adenomatous polyps • The report will include detailed advice on management