title: Same-day assessment and management of urgent (2-week wait) colorectal referrals: an analysis of the outcome of 1606 patients attending an endoscopy unit-based colorectal clinic.
abstract: OBJECTIVE
  The Rapid Access Diagnosis and Remedy (RADAR) clinic combines 2-week wait (TWW) specialist consultation with 'straight-to-test' flexible sigmoidoscopy (FS) for left-sided 'red-flag' TWW criteria (excluding right-sided mass or iron-deficiency anaemia). The study aims were to determine the effectiveness of RADAR in differentiating colorectal cancer from benign disease and to evaluate the need for whole colonic investigation (WCI) following FS, in symptomatic patients.
  
  
  METHODS
  Prospectively collated data of all RADAR patients from November 2005 to November 2009 were analysed, excluding patients referred internally for a FS. The local histology database was later interrogated to detect any missed cancers.
  
  
  RESULTS
  Of 1690 patients (729 men; median (range) age: 68 (18-96) years) assessed in RADAR, 84 were excluded. Colorectal cancer (CRC) was diagnosed in 117 (7.3%). Eighty-seven cancers were diagnosed on the day of attendance and a further 13 within a week (88.9% overall). Two patients after a cancer-free FS were found to have a right-sided CRC on WCI (0.24%) and one synchronous cancer was found. No patient with a cancer-free FS having a WCI was subsequently found to have CRC at a median of 35 (12-58) months.
  
  
  CONCLUSIONS
  Flexible sigmoidoscopy, in the context of an endoscopy unit TWW clinic, allows same-day diagnosis of most patients referred with left-sided symptoms, and immediate reassurance and treatment of most benign diagnoses. For these patients, the use of routine WCI following a cancer-free FS does not appear to be beneficial. Adopting this system would significantly reduce the number of barium enemas and colonoscopies currently performed.
authors.affiliation: General Surgery, City Hospital Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
authors.forename: T J
authors.initials: TJ
authors.lastname: Royle
authors.forename: H J M
authors.initials: HJ
authors.lastname: Ferguson
authors.forename: T W C
authors.initials: TW
authors.lastname: Mak
authors.forename: J A
authors.initials: JA
authors.lastname: Simpson
authors.forename: V
authors.initials: V
authors.lastname: Thumbe
authors.forename: S
authors.initials: S
authors.lastname: Bhalerao
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D001466:Barium Sulfate; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications / Q000175:diagnosis*; D003287:Contrast Media; D003672:Defecation; D004241:Diverticulum, Colon / Q000150:complications / Q000175:diagnosis; D004733:Enema; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006484:Hemorrhoids / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data*; D012812:Sigmoidoscopy; D013997:Time Factors; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate
keywords: Sigmoidoscopy; ambulatory care; colorectal neoplasms; diagnosis; referral and consultation