title: The impact of open access flexible sigmoidoscopy: a comparison of two services.
abstract: BACKGROUND
  Open access flexible sigmoidoscopy (OAFS) is an integral part of colorectal cancer services. This study compares the impact of two types of open-access flexible sigmoidoscopy services on the utilisation of barium enema and tumour-stage migration.
  
  
  METHODS
  This was a non-randomised comparison (over two one-year periods, four years apart) of two unselected groups of patients, with different inclusion criteria, in adjacent similarly populated health districts. One offered a nurse practitioner endoscopy service while the other had a doctor-led colorectal clinic.
  
  
  RESULTS
  The doctor-led service with its broad inclusion criteria detected more colorectal cancers [13.2% versus 0.7%; OR = 16.05; 2.16-119.2]. Neither nurse practitioner (130 cases) nor doctor-led (262 cases) flexible sigmoidoscopy reduced the total number of barium enemas [Odds Ratio (OR) = 1.16 (95% CI 1.03-1.3)]. However, the doctor-led service did reduce the number of barium enemas requested by general practitioners (from 249 to 152). The total number of colorectal cancers (detected by all available methods) were similar [OR = 0.82 (0.53-1.25)] and both services resulted in a similar tumour-stage migration [OR = 1.39 (0.31-6.23)].
  
  
  CONCLUSIONS
  Open access flexible sigmoidoscopy services have minimal impact on the utilisation of radiology services. Broader inclusion criteria of doctor-led services produce a higher cancer-yield. Tumour-stage migration may be related to greater awareness of colorectal cancer symptoms rather than to the type of OAFS.
authors.affiliation: Prince Charles Hospital, Merthyr Tydfil, Wales.
authors.forename: P J
authors.initials: PJ
authors.lastname: Arumugam
authors.forename: G N
authors.initials: GN
authors.lastname: Rao
authors.forename: J
authors.initials: J
authors.lastname: West
authors.forename: M E
authors.initials: ME
authors.lastname: Foster
authors.forename: P N
authors.initials: PN
authors.lastname: Haray
mesh_terms: D001466:Barium Sulfate; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D004733:Enema / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care; D012812:Sigmoidoscopy / Q000379:methods*
chemical_list: D001466:Barium Sulfate