Direct Access Endoscopy
The University of Michigan Health System offers the option of "Direct Access Endoscopy" to referring physicians in an attempt to expedite patient care.
This program provides:
- Primary Care Providers can schedule standard diagnostic endoscopic procedures on stable adult patients quickly and without need of prior consultations.
- Full-time faculty members of the Division of Gastroenterology will perform all procedures.
- Procedural reports will be faxed to the ordering physician and any additional reports (such as biopsy and cytology) from analysis of tissue samples obtained at the time of the procedure will be forwarded subsequently.
- Primary Care Providers maintain control of and responsibility for the patient's care.
- Referring physicians will be responsible for the interpretation of the clinical significance of the endoscopic findings, as well as for arranging for any appropriate further evaluation or treatment.
- Should the findings warrant further discussion, members of the GI Division are available for consultation.
Eligibility Criteria
Colonoscopy, Upper Endoscopy, and Sigmoidoscopy may be scheduled for stable persons with specific accepted indications. Exclusion criteria for this program are also included, along with a list of other relevant information and Scheduling.
Colonoscopy indications include:
1. Colon cancer screening/polyp surveillance
Current guidelines for screening
- Average risk man or woman (every 10 years starting at age 50)
- Family history of colon cancer or polyps:
- 2 or more 1st degree relatives or one 1st degree relative affected at age younger than 60 years (every 5 years starting at age 40 or 10 years earlier than youngest diagnosis in family, whichever is first)
- 1st degree relative at age younger than 60 years (Average risk screening but beginning at age 40 years)
- HNPCC or FAP (genetic counseling & special screening)
Current guidelines for surveillance
- Advanced or multiple ( >3) adenomas: every 3 years
- 1 or 2 small (<1 cm) adenomas: every 5 years
- Personal history of colon cancer: 3 years; then if normal, every 5 years
2. Bleeding
- Unexplained iron deficiency
- Positive fecal blood test
- Rectal bleeding
3. Unexplained chronic diarrhea (longer than 3 weeks duration)
4. Inflammatory bowel disease (patient should have GI follow-up)
- Ulcerative pancolitis or Crohn's colitis for longer than 8 years or left-sided ulcerative colitis for longer than 15 years (repeat every 1 to 2 years)
5. Unexplained weight loss
Upper Endoscopy (EGD) indications include:
- Persistent symptoms of gastroesophageal reflux disease (GERD)
- Persistent dyspepsia
- Dysphagia
- Nausea/vomiting
- Iron deficiency anemia/ melena
- Rule out or follow-up Barrett esophagus
- Unexplained weight loss
Sigmoidoscopy indications include:
- Rectal bleeding
- Rectal pain or tenesmus
- Fecal incontinence
- Unexplained diarrhea
- Colon cancer screening (insurance does not cover colonoscopy or patient prefers sigmoidoscopy)
EXCLUSION CRITERIA for Direct Access Endoscopy
Patient MUST be seen in the Gastroenterology Clinic or contact the endoscopist if any of the following apply:
- Age older than 80 years
- Weight greater than 350 pounds
- Pregnancy
- General anesthesia required
- Patient unable to perform consent
- Artificial heart valve
- Chronic obstructive pulmonary disease (COPD) (forced expiratory volume (FEV) 1 < 1.0)
- Myocardial infarction/angina/severe congestive heart failure for less than 6 months
- Anemia with hematocrit less than 20%
- Coagulopathy / hereditary hemorrhagic disorders / anticoagulation test (international normalized ratio [INR] > 1.5, platelets < 75 K, coumadin, heparin)
- Exception to Exclusion: The PC office will manage the bridging Lovonox or discontinue the anticoagulants (so that coumadin is not an exclusion for direct access)
- Diabetic patient
- Plavix use - if clinically safe, hold for 1 week prior to procedure
- Automatic implanted cardiac defibrillator (ICD) - must be turned off/on in MPU peri-procedure.
ICD manufacturer:_________________________________
Scheduling
Download and complete the Direct Access Endoscopy Requisition. This requisition provides important patient information to the endoscopist. If you have any other clinical information about the patient that you believe would be useful to the endoscopist, please fax it with the Direct Access Endoscopy Requisition.
Send a copy of the Direct Access Endoscopy Requisition to CareWeb Imaged Docs. (Fax with a cover sheet to MIS 734-936-6647).Then, telephone the Endoscopy Call Center (ECC) at (734) 936-9250, option #1, to schedule the appointment.
Thank you for considering the University of Michigan Health System Direct Access Endoscopy Program.
