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Giving GPs direct access to endoscopy boosted early bowel cancer detection

A London hospital has reported a big hike in the number of early-stage colorectal cancer diagnoses as a result of GPs being allowed to refer patients directly to endoscopy services.

Over half of colorectal cancer (CRC) diagnoses made after the introduction of direct access endoscopy were Stage 1 cancers - compared with a national average of less than one in 10 cases.

Homerton University Hospital introduced direct access flexible sigmoidoscopy in 2012, followed by direct access colonoscopy in 2014, in order to speed up referral of patients who do not fulfill the usual two-week wait criteria.

The new system allows GPs to book sigmoidoscopy for patients aged 18-55 with rectal bleeding, and colonoscopy for those aged 40-74 with gastrointestinal symptoms.

Researchers reported at this week’s National Cancer Intelligence Network conference that 564 patients have now been referred through the new system, and seven patients diagnosed with cancer. Four, or 57%, of the patients diagnosed with CRC had Stage 1 disease - compared with 9% nationally using the two-week wait referral system.

The team said this suggested that direct referral could have reduced diagnostic delays and improved the stage at diagnosis for around 80 patients if it had been implemented across the whole of London.

Lead researcher and surgeon Miss Helen Pardoe, who heads up the Homerton colorectal MDT, told Pulse: ‘The most important factor here is that the GPs have direct access to a lower GI endoscopy test without a secondary care triage step.

‘Also, direct access suits the young working population as it minimises the time they need off work by reducing the number of health care appointments they have to attend. The young patient (under 55 years) with occasional rectal bleeding does not fit an urgent referral criteria or referral is via the routine pathway, which can be 12-plus weeks between GP appointment and lower GI endoscopy test.’

National Cancer Intelligence Network - Cancer Outcomes Conference 2015: Abstract O-20

Related images

  • endoscopy screening investigation bowel cancer  PPL

Readers' comments (5)

  • Rapid access proctology clinics and 2ww should cover it.

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  • We have direct access endoscopy in Derby - but using it means a whole load of extra work in terms of information, pre-procedure bloods and prep and surprisingly the GP is responsible for chasing biopsies and acting on the results. If symptoms do not resolve you have to re-refer to the clinic.

    Using direct access is actually a disincentive.

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  • Mustapha Tahir

    Hopefully emergence of GPwS interest in Endoscopy?

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  • I'm very worried about this - the numbers involve are small. Only 7 of the 564 patients (i.e. about 1%) had cancer and 4 out of the 7 had early stage cancer. This is no better than chance surely. Over a life time, there is a 5% chance of anyone getting bowel cancer. Secondly, there is no evidence to suggest that these early cancers won't be indolent.

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  • Samuel Lewis

    Anonymous is spot on - 7 cancers in 564 referred is only 1.2 %

    the new NICE cancer guidance talks of lowering referral thresholds to a 3% cancer risk !

    Shome mishtake shurely ?

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