title: Open-access versus hospital-initiated flexible sigmoidoscopy: a comparative audit of efficacy.
abstract: OBJECTIVE
  There is a continuing demand for the provision of open-access endoscopy services. While open-access gastroscopy is now a well-established practice in most hospitals, open-access flexible sigmoidoscopy (OAS) is not yet available to the same extent. We present our early experience with OAS, a new service provided by our unit.
  
  
  RESULTS
  Over a 12-month period, 255 flexible sigmoidoscopies were carried out (139 OAS and 116 hospital-initiated sigmoidoscopies, HIS). Referral criteria for sigmoidoscopy were similar in both groups, with rectal bleeding and change in bowel habit being the most frequent.
  
  
  RESULTS
  The two groups were comparable with regards to age and gender, but patients referred for OAS had symptoms for shorter duration than those referred for HIS (30 +/- 5.6 months v. 101 +/- 28 months, P < 0.00001). The diagnostic yield for OAS was 44% and for HIS 29% (P= 0.01). Significant pathology (colorectal cancer, polyps and newly diagnosed inflammatory bowel disease, colonic strictures) was detected in 31 patients (22%) in the OAS group and 12 patients (10%) in the HIS group (P = 0.02). Six cancers were diagnosed (5 OAS, 1 HIS), all staged Duke A. The waiting times for OAS and HIS were 3.1 +/- 0.3 weeks and 11.4 +/- 1.2 weeks, respectively (P = 0.0001). The diagnostic yield of fibre-optic endoscopy was independent of duration of symptoms, although patients referred for OAS with rectal bleeding and/or diarrhoea had a higher diagnostic yield (55/125, 44%).
  
  
  CONCLUSIONS
  OAS is feasible and effective, with a high diagnostic yield. Such service can usually be provided with minimal added resources.
authors: Department of Gastroenterology, Hull Royal Infirmary, UK. sumitaverma6@hotmail.com
authors: S
authors: S
authors: Verma
authors: M H
authors: MH
authors: Giaffer
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D005194:Family Practice / Q000592:standards / Q000639:trends; D005260:Female; D005336:Fiber Optic Technology; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards* / Q000639:trends; D008485:Medical Audit; D008875:Middle Aged; D011336:Probability; D012017:Referral and Consultation / Q000592:standards* / Q000639:trends; D012680:Sensitivity and Specificity; D020694:Sigmoidoscopes; D012812:Sigmoidoscopy / Q000379:methods*; D016896:Treatment Outcome; D006113:United Kingdom