title: How important is it to investigate the whole of the colon after initial assessment at a rapid access colorectal clinic?
abstract: BACKGROUND
  The Stirling Royal Infirmary Rapid Access Colorectal Clinic (RACC) is a one-stop clinic that uses flexible sigmoidoscopy as the initial investigation to diagnose patients referred urgently with colorectal symptoms. This study aimed to examine the diagnoses and outcomes of patients who attended the RACC in 2006.
  
  
  METHODS
  All patients who attended the RACC from 1 January 2006 to 31 December 2006 were identified and retrospectively reviewed from our prospectively collected unit database and case notes.
  
  
  RESULTS
  Five hundred ninety-one patients attended the RACC in 2006. One hundred sixteen (19.6%) patients were discharged after the first clinic attendance, and the remaining 475 (80.4%) had further investigations or clinic review. There were 370 barium enemas requested with 92.4% compliance. The most common pathology identified by barium enemas was diverticular disease which only required reassurance and lifestyle changes. There were nine false-positive findings from barium enemas requiring further investigations. Of the 105 patients without barium enema, 49 had a colonoscopy. In total, 42 colorectal cancers were diagnosed with 34 (81.0%) distal to the splenic flexure and eight (19.0%) proximal. Of these, 32 (76%) were diagnosed by flexible sigmoidoscopy, three (7%) by barium enemas, three (7%) by colonoscopy, and four (10%) by computed tomography.
  
  
  CONCLUSIONS
  A rapid access colorectal clinic using flexible sigmoidoscopy as the initial diagnostic test was safe and effective in investigating distal colonic pathologies. However, over two thirds of patients proceeded to imaging of the remaining colon, and most of them were found to have only benign pathologies. The cost effectiveness and acceptability of this were unclear.
authors.affiliation: Department of General Surgery, Stirling Royal Infirmary, Forth Valley NHS, Livilands, Stirling FK8 2AU, UK.
authors.forename: Chung Sim
authors.initials: CS
authors.lastname: Lim
authors.forename: Linnet
authors.initials: L
authors.lastname: McGeever
authors.forename: Judith Helen
authors.initials: JH
authors.lastname: Grey
authors.forename: Arunachalam
authors.initials: A
authors.lastname: Krishna
authors.forename: Aijaz Ahmed
authors.initials: AA
authors.lastname: Jabbar
authors.forename: Wilson Stephen
authors.initials: WS
authors.lastname: Hendry
mesh_terms: D001466:Barium Sulfate; D003106:Colon / Q000473:pathology*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D004733:Enema; D006801:Humans
chemical_list: D001466:Barium Sulfate