Colonoscopy (direct access) - Adult
Colonoscopy (direct access) - Adult
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:
To contact the relevant service, please see Clinician Assist WA: 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*
- Altered 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
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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:
- 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
|
Feedback
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Indicative clinical urgency category
Indicative clinical urgency 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
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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
|
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Patients younger than 45 years who have altered bowel habit in absence of alarm symptoms |
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Useful information for referring practitioners (not exhaustive list)
Last reviewed: 03-10-2023