The colorectal rapid access clinic (RA) was established in our district general hospital in 2001 to provide a streamlined diagnostic service for patients with suspected colorectal cancer (CRC). It offers direct clinician-led flexible sigmoidoscopy (FS) when appropriate clinical criteria are met (i.e. distal colonic symptoms) as indicated on the GP referral form. Video FS is carried out in JAG-approved facilities in the OP clinic. For many patients this acts as a ‘one-stop’ clinic and reduces the need for further attendance. The aim of this study was to provide a descriptive review and evaluate patient outcomes over a 4 year period.Methods
A retrospective analysis of electronic records was carried out for all patients undergoing FS as first investigation during the 12 month period of January-December 2013. Demographics, clinical indications, FS diagnosis, further investigations and final diagnosis were recorded and analysed. A subgroup analysis was carried out according to clinical presentation and cancer outcomes were validated with the Somerset CRC database.Results
1021 patients underwent FS in the RA clinic. Mean age was 72.5 years, 1.1 F:M ratio. The main referral criteria were rectal bleeding (41.8%), diarrhoea (37.0%), unspecified altered bowel habit (13.8%), constipation (7.4%), abdominal pain (5.1%) and weight loss (2.6%). Diagnosis at examination was: normal (24.8%), diverticulosis (32.9%), polyps (17.5%), haemorrhoids (26.8%), malignancy (5.2%). Further investigations done after FS included barium enema (30%), colonoscopy (21%), contrast abdominal CT (35%) or CT colonogram (0.5%). A further 16 cases (1.5%) were diagnosed with CRC after full colonic assessment. Discharge rate was 12.9% after FS and 76.2% following further investigations. Follow up of patients discharged after RA assessment revealed that four new cases of CRC (0.4%) were diagnosed within 3 years of discharge.Conclusions
This unique RA pathway, with FS followed by selective referral for further colonic assessment, offers a quick and reliable service for the exclusion of suspected CRC with excellent diagnostic accuracy. The incidence of interval CRC is within acceptable limits as compared with other colonic imaging.