Authors (including presenting author) :
Cheung WW(1), Chan KW(1), Lai PY(1), Yiu MP(1), Tsang CF(1), Chan CW(1), Luk W(1), Yiu YK(1), Cheung WI(2), Wong WC(2), Chiu YW(3), Lau CN(3)
Affiliation :
(1)Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority,(2)Department of Medicine, Our Lady Of Maryknoll Hospital, (3) Department of Surgery, Our Lady Of Maryknoll Hospital
Introduction :
Fresh rectal bleeding is a common and important presenting symptom in the consultation of general practice. Anal fissure and haemorrhoids remain to be the most commonly encountered causes, but it can be the result of colorectal cancer bleeding. In the public setting in Hong Kong, the waiting time for colonoscopy is very long. For example, the routine colonoscopy waiting time in one of the regional hospitals at KWC was 105 weeks in July 2018. Flexible sigmoidoscopy (FS) has the disadvantage of not examining the right sided colon. However, from the literature, it is regarded as a valuable initial investigation for patients presenting with bright red rectal bleeding. It was proved to produce high diagnostic yield and it expedited the management of patients with colorectal symptoms. It could reduce delaying in diagnosing colorectal pathology. This study examines the role of direct access FS performed by Family Physicians. Family Medicine specialists from KWC can book direct access FS performed by Family Physicians, in collaboration with the endoscopy unit of Our Lady Of Maryknoll Hospital(OLMH). Patients who presented with bright red rectal bleeding, without other bowel symptoms, systemic upset or features of anaemia, referred for FS were studied.
Objectives :
1/ To review the safety profile and the diagnostic yield of flexible sigmoidoscopy performed by family physicians. 2/ To evaluate the service model on the use of direct access flexible sigmoidoscopy at primary care setting.
Methodology :
Patients referred from primary care clinic for FS during the period of 1/2016-3/2018 were studied. The procedure was conducted at the endoscopy unit of OLMH. The waiting time for the procedure, extent of endoscopic examination, endoscopic findings, complications, subsequent needs of colonoscopy and specialist referral were studied.
Result & Outcome :
456 patients with 224 men and 232 women were studied. Their age ranges from 23 to 84 (Mean age 54.5). Complete FS up to 60cm or beyond was achieved in 443 (97.1%) patients. 13 incomplete cases were either due to poor bowel preparation, patients' intolerance or acute kink of bowel. Two patients were found to have adenocarcinoma at the sigmoid colon and the rectosigmoid junction. Their waiting time for FS was 5 months and 4 months respectively. They eventually underwent surgical resection with histological confirmation of T3N0M0 Dukes' B disease. Seventy-four (16.4%) patients were found to have adenomatous polyp. Thirty-one patients were found to have other colorectal pathologies which included diverticulum, proctitis, melanosis coli, colitis, rectal ulcer and lipoma. Haemorrhoids were identified in 404 patients. The overall diagnostic yield for FS was 36.2%. Eighty-one (17.8%) patients required booking for colonoscopy at their subsequent follow up. Twenty-six (5.7%) patients needed specialist referral whereas 94.3% of them remained to receive their medical care at the primary care setting after FS. The average waiting time for FS was 7.2 months. In concern with complications, there was no bleeding, perforation or cardiopulmonary complication recorded. Conclusion: FS can be performed safely by trained Family Physicians, provided with adequate support from hospital specialist and endoscopy unit. It helps to triage and expedites the management of patients who present with fresh rectal bleeding.
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