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Coloproctology procedure clinic: a novel service developed to reduce suffering of patients with bleeding per rectum

  • Yasir Bashir
  • Bernadette McGovern
  • Mohammed Tahtouh
  • Tahir Abbasi
  • Maria Murphy
  • Paul Neary
Original Article

Abstract

Aims

Evaluation of the role and impact of introducing a dedicated coloproctology procedure clinic in tertiary referral colorectal unit.

Methods

A retrospective analysis of 126 consecutive patients managed in the coloproctology clinic between March2015 and September 2016 was carried out. All patients were preselected for attendance based on symptom-based protocol.

Results

Based on the information available in GP referrals, 126 patients with bleeding per rectum with low risk of cancer were re-triaged from the general outpatient to dedicated coloproctology procedure clinic. Those patients accounted for 14% of waiting list. The average waiting time to attend clinic was 27 months from referral to undergoing definitive procedure. A proctoscopy or/and rigid sigmoidoscopy was performed in patients. Seventy-nine (89.7%) patients were completely managed and discharged after attending their first visit. Sixty-seven (76%) patients had 2nd- or 3rd-degree haemorrhoids and were treated with rubber band ligation (RBL) or phenol injection in outpatient setting. Two patients had an anal fissure and were managed conservatively with medication. After clinic, follow-up was through telephone clinic. This avoids attendance physically in the hospital. Symptoms persisted in nine patients and were subsequently scheduled for colonoscopy, three had benign polyps. With the introduction of the procedure clinic, the waiting time from referral to treatment was reduced from 27 to 6 months (p < 0.05).

Conclusions

Establishing a dedicated “Coloproctology procedure clinic” is an effective strategy in reducing number of hospital visits per patient and hospital waiting list. This innovative clinic reduces utilisation of precious endoscopy unit resources. This ultimately will improve endoscopy efficiency.

Keywords

Benign colorectal disease Bleeding per rectum Colonoscopy Colorectal cancer Haemorrhoids Rubber band ligation 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Knight J, Senapati A, Lamparelli M (2008) National UK audit of procedure for prolapsing haemorrhoids on behalf of the Association of Coloproctology of Great Britain and Ireland. Color Dis 10(5):440–445CrossRefGoogle Scholar
  2. 2.
    Davila RE, Rajan E, Adler DG, Egan J, Hirota WK, Leighton JA et al (2005) ASGE Guideline: the role of endoscopy in the patient with lower-GI bleeding. Gastrointest Endosc 62(5):656–660CrossRefPubMedGoogle Scholar
  3. 3.
    Pasha SF, Shergill A, Acosta RD, Chandrasekhara V, Chathadi KV, Early D et al (2014) The role of endoscopy in the patient with lower GI bleeding. Gastrointest Endosc 79(6):875–885CrossRefPubMedGoogle Scholar
  4. 4.
    Hardy A, Chan C, Cohen C (2005) The surgical management of haemorrhoids—a review. Dig Surg 22(1–2):26–33CrossRefPubMedGoogle Scholar
  5. 5.
    Dent OF, Goulston KJ, Zubrzycki J, Chapuis PH (1986) Bowel symptoms in an apparently well population. Dis Colon Rectum 29(4):243–247CrossRefPubMedGoogle Scholar
  6. 6.
    Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58(2):71–96CrossRefPubMedGoogle Scholar
  7. 7.
    Spinzi G, Dal Fante M, Masci E, Buffoli F, Colombo E, Fiori G et al (2007) Lack of colonic neoplastic lesions in patients under 50 yr of age with hematochezia: a multicenter prospective study. Am J Gastroenterol 102(9):2011–2015CrossRefPubMedGoogle Scholar
  8. 8.
    Bhagatwala J, Singhal A, Aldrugh S, Sherid M, Sifuentes H, Sridhar S (2015) Colonoscopy—indications and contraindications. Screening for Colorectal Cancer with Colonoscopy, InTech.  https://doi.org/10.5772/61097
  9. 9.
    Potter JD, Slattery ML, Bostick RM, Gapstur SM (1993) Colon cancer: a review of the epidemiology. Epidemiol Rev 15(2):499–545CrossRefPubMedGoogle Scholar
  10. 10.
    Hakama M, Hoff G, Kronborg O, Påhlman L (2005) Screening for colorectal cancer. Acta Oncol 44(5):425–439CrossRefPubMedGoogle Scholar
  11. 11.
    Mandel J, Church T, Ederer F (1993) Screening for colorectal cancer. N Engl J Med 329(18):1353–1354Google Scholar
  12. 12.
    Nisar PJ, Scholefield JH (2003) Managing haemorrhoids. BMJ Br Med J 327(7419):847CrossRefGoogle Scholar
  13. 13.
    Lohsiriwat V (2012) Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol: WJG 18(17):2009CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lee HH, Spencer RJ, Beart RW (1994) Multiple hemorrhoidal bandings in a single session. Dis Colon Rectum 37(1):37–41CrossRefPubMedGoogle Scholar
  15. 15.
    Lau W, Chow H, Poon G, Wong S (1982) Rubber band ligation of three primary hemorrhoids in a single session. Dis Colon Rectum 25(4):336–339CrossRefPubMedGoogle Scholar
  16. 16.
    Khubachandani IT (1983) A randomized comparison of single and multiple rubber band ligations. Dis Colon Rectum 26(11):705–708CrossRefGoogle Scholar
  17. 17.
    Wrobleski DE, Corman ML, Veidenheimer MC, Coller JA (1980) Long-term evaluation of rubber ring ligation in hemorrhoidal disease. Dis Colon Rectum 23(7):478–482CrossRefPubMedGoogle Scholar
  18. 18.
    Savioz D, Roche B, Glauser T, Dobrinov A, Ludwig C, Marti M-C (1998) Rubber band ligation of hemorrhoids: relapse as a function of time. Int J Color Dis 13(4):154–156CrossRefGoogle Scholar
  19. 19.
    Mattana C, Maria G, Pescatori M (1989) Rubber band ligation of hemorrhoids and rectal mucosal prolapse in constipated patients. Dis Colon Rectum 32(5):372–374CrossRefPubMedGoogle Scholar
  20. 20.
    Whitlock EP, Lin JS, Liles E, Beil TL, Fu R (2008) Screening for colorectal cancer: a targeted, updated systematic review for the US Preventive Services Task ForceScreening for Colorectal Cancer. Ann Intern Med 149(9):638–658CrossRefPubMedGoogle Scholar
  21. 21.
    Dominitz JA, Eisen GM, Baron TH, Goldstein JL, Hirota WK, Jacobson BC et al (2003) Complications of colonoscopy. Gastrointest Endosc 57(4):441–445CrossRefPubMedGoogle Scholar
  22. 22.
    Bressler B, Paszat LF, Vinden C, Li C, He J, Rabeneck L (2004) Colonoscopic miss rates for right-sided colon cancer: a population-based analysis. Gastroenterology 127(2):452–456CrossRefPubMedGoogle Scholar
  23. 23.
    Bressler B, Paszat LF, Chen Z, Rothwell DM, Vinden C, Rabeneck L (2007) Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology 132(1):96–102CrossRefPubMedGoogle Scholar
  24. 24.
    Kasugai K, Miyata M, Hashimoto T, Todoroki I, Tsutsui S, Nagase F et al (2005) Assessment of miss and incidence rates of neoplastic polyps at colonoscopy. Dig Endosc 17(1):44–49CrossRefGoogle Scholar
  25. 25.
    Studdert DM, Mello MM, Sage WM, DesRoches CM, Peugh J, Zapert K et al (2005) Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA 293(21):2609–2617CrossRefPubMedGoogle Scholar
  26. 26.
    Summerton N (1995) Positive and negative factors in defensive medicine: a questionnaire study of general practitioners. BMJ 310(6971):27–29CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Hiyama T, Yoshihara M, Tanaka S, Urabe Y, Ikegami Y, Fukuhara T et al (2006) Defensive medicine practices among gastroenterologists in Japan. World J Gastroenterol: WJG 12(47):7671CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Ortashi O, Virdee J, Hassan R, Mutrynowski T, Abu-Zidan F (2013) The practice of defensive medicine among hospital doctors in the United Kingdom. BMC Med Ethics 14(1):42CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Asher E, Greenberg-Dotan S, Halevy J, Glick S, Reuveni H (2012) Defensive medicine in Israel—a nationwide survey. PLoS One 7(8):e42613CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Bishop TF, Federman AD, Keyhani S (2010) Physicians’ views on defensive medicine: a national survey. Arch Intern Med 170(12):1081–1083PubMedGoogle Scholar
  31. 31.
    Beuscart R (2009) The problem of defensive medicine: two Italian surveys. Detect Prev Adverse Drug Events: Inf Technol Hum Factors 148:206Google Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2018

Authors and Affiliations

  1. 1.Department of Surgery, Trinity Centre of Learning and DevelopmentTallaght HospitalDublin 24Ireland
  2. 2.Professorial Surgical Unit, Department of SurgeryThe University of Dublin Trinity College, Tallaght HospitalDublinIreland

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