Open access fibresigmoidoscopy: a comparative audit of efficacy

Area of Science:

• Gastroenterology
• Endoscopy
• Colorectal Cancer Screening

Background:

• Flexible sigmoidoscopy is a key diagnostic tool for lower gastrointestinal symptoms.
• Evaluating the effectiveness of open access versus hospital-initiated procedures is crucial for optimizing healthcare delivery.

Purpose of the Study:

• To compare the diagnostic yield and outcomes of open access flexible sigmoidoscopy with hospital-initiated procedures.
• To assess the appropriateness of open access referrals and identify patient groups with varying diagnostic yields.

Main Methods:

• A retrospective comparison of 541 open access and 495 hospital-initiated flexible sigmoidoscopies over five years.
• Analysis of diagnostic yield, detection rates of colorectal carcinoma (including Dukes' stage), polyps, colitis, and diverticular disease.
• Evaluation of referral justification and need for further investigations.

Main Results:

• Open access flexible sigmoidoscopy referrals doubled, with stable diagnostic yields (~40%) comparable to hospital procedures.
• Colorectal cancer detection rates were similar, with 34% of lesions being early-stage (Dukes' A) in both groups.
• High diagnostic yields (>90%) were observed for rectal bleeding and diarrhoea, while yields were low (<19%) in younger patients (<40) or those with constipation, suggesting irritable bowel syndrome.

Conclusions:

• Open access flexible sigmoidoscopy is an effective and efficient service for diagnosing lower gastrointestinal conditions.
• The service demonstrates high diagnostic accuracy for specific indications like rectal bleeding and diarrhoea.
• Consideration should be given to refining referral criteria, particularly for younger patients or those with constipation, to improve resource allocation.