The impact of open access flexible sigmoidoscopy: a comparison of two services

Background: Open access flexible sigmoidoscopy (OAFS) is an integral part o f colorectal cancer services. This study compares the impact of two types o f open-access flexible sigmoidoscopy services on the utilisation of barium enema and tumour-stage migration, Method: This was a non-randomised compari son (over two one-year periods, four years apart) of two unselected groups of patients, with different inclusion criteria, in adjacent similarly popul ated health districts. One offered a nurse practitioner endoscopy service w hile 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 to tal number of barium enemas [Odds Ratio (OR) = 1.16 (95 % CI 1.03-1.3)]. Ho wever, the doctor-led service did reduce the number of barium enemas reques ted by general practitioners (from 249 to 152), The total number of colorec tal 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)]. Conclusion: Open access flexible sigmoidoscopy services have minimal impact on the utilisation of radiology services. Broader inclu sion criteria of doctor-led services produce a higher cancer-yield. Tumour- stage migration may be related to greater awareness of colorectal cancer sy mptoms rather than to the type of OAFS.