Direct Access Endoscopy

Key features:

From referral direct to endoscopy test
No need for a preliminary consultation

Any medically stable adult (18-80) patient with specific accepted indication(s) for endoscopy test(s) is suitable for Direct Access Endoscopy.


Accepted indications:


OGD and/or Colonoscopy

Iron deficiency anaemia with clinical suspicion of gastrointestinal (GI) blood loss

OGD

Dyspepsia (upper abdominal discomfort or pain) not responding to therapy
Abnormal upper GI radiology (suspected neoplasm, peptic ulcer, stricture or obstruction)

Colonoscopy

Change of bowel habit or polyp screening/follow up
Abnormal barium enema (filling defect or stricture) or CT colon
Occult blood in stool or bright red blood per rectum

ERCP or EUS

Clinically suspected or confirmed bile duct gallstones or obstructed bile system

EUS

Tissue sampling (coeliac or mediastinal lymph nodes, pancreatic mass or cystic lesion)


Background

Direct Access Endoscopy may also be known as ‘Straight to Test’ or ‘Open Access Endoscopy’. The patient proceeds to the endoscopy test without a preliminary consultation with the endoscopist/gastroenterologist.

In the UK, the patient’s General Practitioner or a medical specialist can assess and decide on the need for an endoscopy. The patient may have attended a secondary care NHS outpatient consultation and awaiting a specific endoscopy test. He/she may have had a previous endoscopy test and requires a repeat or follow up surveillance procedure. These patients may wish to proceed with the endoscopy test without another formal consultation visit, potentially reducing delay and saving cost.

 
How to book

The patient may be referred by his/her GP or another medical specialist. Some patients may be more suitable for the One Stop Clinics.

Call Michelle Huxley on 01926 436 342 or email michelle.huxley@nuffieldhealth.com to discuss your patient’s requirements.


Fast and easy access to a specialist test

Following the referral, the patient will get an appointment to have the appropriate test done urgently. Most patients will have the test within 2 weeks. My secretary will contact the patient (usually by phone), to advise on the preparation required prior to attending.

On the day of endoscopy test, the patient is seen on the ward or endoscopy unit just prior to the test for a short discussion and consent.

It is a prerequisite that any patient requiring an endoscopy test is informed of the risks, benefits, and alternatives. Please advise the patient to review the linked pages:


Endoscopy test information


Direct Access Endoscopy is not appropriate for any patient who:

has a prior problem with sedation +/- anaesthesia
has a bleeding disorder
takes regular blood thinning medications such as warfarin or clopidogrel
is unstable or acutely bleeding
has a ‘contraindication for endoscopy’ such as known or suspected perforation, severe or acute diverticulitis, fulminant colitis, uncorrectable coagulopathy or thrombocytopenia, unstable cardiac or pulmonary conditions


Please note:

The service is currently available for private referrals only
A serious acute or chronic illness such as heart, kidney, liver, neurologic (previous stroke or TIA), lung disease, or diabetes for which the patient is currently under treatment may affect his/her eligibility for Direct Access Endoscopy.
The endoscopist may (rarely) discover other circumstances prior to the procedure that affect the patient’s suitability for Direct Access Endoscopy.
The service may be available on specific days only and by prior arrangement, at least one week in advance.
The patient who has an unexpected finding (e.g. requires oesophageal dilation) or incomplete procedure may be required to undergo another endoscopy on a separate occasion

 
Follow up

When there is no sinister diagnosis found, the patient is normally discharged to the referrer (GP or medical specialist) for follow up or treatment where indicated. The endoscopy reports will be faxed promptly or sent by mail. The results of tissue sample analysis with management recommendations will be sent as quickly as feasible.

If an abnormality (e.g. a cancer) is found, arrangements are made immediately for further investigations and follow up.