1. Direct Access Flexible Sigmoidoscopy Pathway for GPs
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 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
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 HB< 11g/dl
Post menopausal women < 10g/dl
Referral to:
St George’s Healthcare NHS Trust
Fax Number:
Tel Number:
Complete referral form and fax to
St George’s Healthcare NHS Trust within 24 hours
Fax Number:
Tel Number:
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-assessment with nurse endoscopist
Flexible sigmoidoscopy
DNA
discharge back to GP
Letter to GP within 5 days with outcome of consultation
Cancer Suspected
Enter colorectal pathway
Further investigations
Discuss at colorectal MDT
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
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