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Colonoscopy (direct access) - Adult

Colonoscopy (direct access) - Adult

From 27 September 2022 the NEW Direct Access Gastrointestinal Endoscopy Referral Form will apply to all Direct Access Gastrointestinal Endoscopy requests submitted via Central Referral Service for public metropolitan hospitals in WA.
Emergency and immediate referrals

Referral to Emergency Department:

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region:

  • Life threatening symptoms suggestive of
    • Bowel obstruction
    • Abdominal sepsis
    • Acute severe colitis
    • Acute large volume rectal bleeding

Immediately contact the on-call registrar or service to arrange an immediate gastroenterology assessment (seen within 7 days) for:

  • Nil

To contact the relevant service, please see HealthPathways: Acute Gastroenterology Assessment

Presenting issues
  • Rectal bleeding (multiple occurrences or continuous) for >4 weeks
  • Positive iFOBT where a colonoscopy has not been performed within the last 2 years
  • Altered bowel habit >6 weeks AND in presence of alarm symptoms*
  • Alerted bowel habit >6 weeks, age ≥45
  • Diarrhoea >6 weeks with negative stool culture
  • Unexplained iron deficiency +/- anaemia with no identified cause and/or unresponsive to treatment
  • Mass or abnormal imaging
  • After first episode of proven diverticulitis to exclude neoplasm (refer 6 weeks post primary presentation)
  • Surveillance procedures required within 12 months (HealthPathways: Colonoscopy Surveillance)

*Alarm Symptoms:

  • Persistent rectal bleeding
  • Unexplained progressive weight loss
  • Persistent severe abdominal pain
  • Unexplained iron deficiency anaemia
  • Bloody diarrhoea with negative stool MC&S
Mandatory referral information (referral will be returned if this information is not included)
  • Reason for referral:
    • At least one indication must be ticked under the following sections, or an adequate description provided:
      • Lower GI indication
  • Medical history, risk factors and current medications list including:
    • Weight – if exact weight is not known an estimate must be provided
    • Indicate if the patient has cardiac stents/pacemaker/implanted defibrillator (if history of heart disease)
    • List of anti-coagulation medications, and the indication for prescription
  • Evidence to support reason for referral must be attached e.g.
    • Length of time and/or number of episodes for rectal bleeding
    • Description of bowel habit changes
    • Stool MC&S for diarrhoea
    • FBC and Ferritin results for unexplained iron deficiency anaemia
    • Imaging
    • Weight loss %
    • U&Es for patients with kidney disease
    • LFTs/INR/Platelets for patients with liver disease
Highly desirable referral information
  • iFOBT result
  • Results of any additional tests that have been undertaken as part of management to date
  • Summary results of any previous colonoscopy
 
Indicative triage category
Indicative triage category
Category 1
Appointment within 30 days
  • Rectal bleeding for >4 weeks, AND any one of:
    • Positive iFOBT
    • unexplained anaemia
    • bloody diarrhoea with negative stool MC&S
    • age ≥45 years
  • Rectal bleeding for >4 weeks, age <45 years and alarm symptoms or elevated CRP
  • Positive iFOBT AND ≥45 years
  • Altered bowel habit >6 weeks and alarm symptoms
  • Diarrhoea >6 weeks with negative stool culture and raised faecal calprotectin or stool leukocytes
  • Unexplained iron deficiency +/- anaemia in men or non-menstruating women and presence of other alarm symptoms
  • Mass palpable (abdominal or rectal) OR likely colorectal mass on imaging 
Category 2
Appointment within 90 days
  • Rectal bleeding for >4 weeks, age <45 years in the absence of alarm symptoms
  • Positive iFOBT and <45 years
  • Altered bowel habit >6 weeks in the absence of alarm symptoms in patients ≥45 years.
  • Diarrhoea >6 weeks with negative stool culture
  • Unexplained iron deficiency +/- anaemia with no identified cause and/or unresponsive to treatment
  • Abnormal imaging, unlikely colorectal cancer
  • 6 weeks post primary presentation for acute diverticulitis
  • Procedures due as per NHMRC Clinical Practice Guidelines for surveillance colonoscopy 
Category 3
Appointment within 365 days
  • No defined category 3 criteria
Excluded gastrointestinal endoscopy services

Referral to public adult gastrointestinal endoscopy (direct access) services is not routinely accepted for the following conditions:

Condition Details (where applicable)
Anaemia not due to iron deficiency
Positive iFOBT in the context of a recent (within 2 years), complete colonoscopy
  • If still concerned call on-call registrar to discuss value of referral for repeat endoscopy procedure.
Patients with diarrhoea ≤6 weeks or those with diarrhoea >6 weeks without evidence of stool specimen
Patients younger than 45 years who have altered bowel habit in absence of alarm symptoms
Useful information for referring practitioners (not exhaustive list)
Last reviewed: 03-10-2023

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