Direct Access Endoscopy


Key Features:

  • From the referral directly to the endoscopy test
  • No need for a preliminary consultation

Any medically stable adult (18-80) patient with specific accepted indication(s) for an endoscopy test 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

  • Strong clinical suspicion or imaging findings of bile duct gallstones, or obstructed bile system
  • EUS guided 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.

A patient in the UK may have seen their General Practitioner (GP), or another medical specialist, who could recommend the need for an endoscopy. He/ she may have had a previous endoscopy test and requires a repeat or follow up surveillance procedure. These patients may wish to proceed straight to 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:



Direct Access Endoscopy is Not Appropriate for any Patient Who:

  • Has a prior problem with sedation +/- anaesthesia
  • Has a bleeding disorder
  • Cannot stop 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 no sinister diagnosis is 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.


Specialist Endoscopies and more  . . .

Endoscopy Plus Limited. Registered in England and Wales No. 7943622 at Oakmoore Court, Kingswood Road, Hampton Lovett, Droitwich, Worcestershire WR9 0QH