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: 020 8725 0778 Tel Number: 020 8725 1111 cancerreferraloffice@stgeorges.nhs.uk Complete referral form and fax to St George’s Healthcare NHS Trust within 24 hours Fax Number: 020 8725 0778 Tel Number: 020 8725 1111 cancerreferraloffice@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-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