Direct Access Flexible Sigmoidoscopy
description
Transcript of Direct Access Flexible Sigmoidoscopy
![Page 1: Direct Access Flexible Sigmoidoscopy](https://reader035.fdocuments.in/reader035/viewer/2022070417/56815570550346895dc33cfb/html5/thumbnails/1.jpg)
Mr Sanjay Wijeyekoon – Consultant Colorectal Surgeon
Dr Rob Palmer – GPwSI Gastroenterology
![Page 2: Direct Access Flexible Sigmoidoscopy](https://reader035.fdocuments.in/reader035/viewer/2022070417/56815570550346895dc33cfb/html5/thumbnails/2.jpg)
Direct Access Flexible SigmoidoscopyA diagnostic service for GPs to assist them
with the management of patients under the age of 55yrs presenting to primary care with rectal bleeding.
![Page 3: Direct Access Flexible Sigmoidoscopy](https://reader035.fdocuments.in/reader035/viewer/2022070417/56815570550346895dc33cfb/html5/thumbnails/3.jpg)
Patient presents with rectal bleeding
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)
Red flag symptoms or signs
No other GI sx Age <55yrs
History - Age of onset - Nature of rectal bleeding - Weight loss, altered bowel habit, abdominal pain - FH of cancer, polyps or IBD Examination - Abdominal - Rectal examination (+/- proctoscopy) Investigations - FBC, CRP, ESR - Stool culture (if increased frequency)
Refer under 2 week rule
Consider routine referral to secondary care – to consider colonoscopy and other Ix
Referral for Direct Access Flexible Sigmoidoscopy
If symptoms settle <4wks reassure
Treat pathology found
If symptoms persist >4w, if symptoms recur or if no perianal pathology found
![Page 4: Direct Access Flexible Sigmoidoscopy](https://reader035.fdocuments.in/reader035/viewer/2022070417/56815570550346895dc33cfb/html5/thumbnails/4.jpg)
History & Examination
![Page 5: Direct Access Flexible Sigmoidoscopy](https://reader035.fdocuments.in/reader035/viewer/2022070417/56815570550346895dc33cfb/html5/thumbnails/5.jpg)
2 week wait referral criteria All ages
Definite, palpable, right sided, abdominal mass 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 stools persisting 6 wks WITHOUT rectal bleeding
![Page 6: Direct Access Flexible Sigmoidoscopy](https://reader035.fdocuments.in/reader035/viewer/2022070417/56815570550346895dc33cfb/html5/thumbnails/6.jpg)
Routine Referral to Secondary CareNo 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)
![Page 7: Direct Access Flexible Sigmoidoscopy](https://reader035.fdocuments.in/reader035/viewer/2022070417/56815570550346895dc33cfb/html5/thumbnails/7.jpg)
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
![Page 8: Direct Access Flexible Sigmoidoscopy](https://reader035.fdocuments.in/reader035/viewer/2022070417/56815570550346895dc33cfb/html5/thumbnails/8.jpg)
Referral for DAFSChoose and Book
Under Diagnostic EndoscopyDirectly bookable appointment
Appointments available on Monday afternoons
Complete referral form and send electronically with CAB
Give patient information leaflet to patient
![Page 9: Direct Access Flexible Sigmoidoscopy](https://reader035.fdocuments.in/reader035/viewer/2022070417/56815570550346895dc33cfb/html5/thumbnails/9.jpg)
![Page 10: Direct Access Flexible Sigmoidoscopy](https://reader035.fdocuments.in/reader035/viewer/2022070417/56815570550346895dc33cfb/html5/thumbnails/10.jpg)
Information for patients - medicationsAspirin & Clopidogrel:
ContinueNo contraindication to diagnostic procedure +/- biopsies
on aspirin or clopidogrel
Warfarin: ContinueGP 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
![Page 11: Direct Access Flexible Sigmoidoscopy](https://reader035.fdocuments.in/reader035/viewer/2022070417/56815570550346895dc33cfb/html5/thumbnails/11.jpg)
Information for patients – the procedureBowel prepConsentProcedure
Advocacy / Transport
![Page 12: Direct Access Flexible Sigmoidoscopy](https://reader035.fdocuments.in/reader035/viewer/2022070417/56815570550346895dc33cfb/html5/thumbnails/12.jpg)
Unsuitable PatientsAcute anal pain suggestive of anal fissure
(procedure unlikely to be tolerated)Recent MI or CVA within 6wObesity (overall weight >135kg)DementiaPoor mobility (need to be able to transfer
from chair to bed)
![Page 13: Direct Access Flexible Sigmoidoscopy](https://reader035.fdocuments.in/reader035/viewer/2022070417/56815570550346895dc33cfb/html5/thumbnails/13.jpg)
Follow-upAll patients will be discharged back to
primary care following this procedure unless diagnosis of serious pathology found:malignancyIBDadenomatous polyps
The report will include detailed advice on management