Polyp surveillance

Emergency department referrals

All urgent cases must be discussed with the on call Gastroenterology Registrar to obtain appropriate prioritisation and treatment. Contact through

  • Royal Brisbane and Women's Hospital (07) 3646 8111
  • The Prince Charles Hospital (07) 3139 4000
  • Redcliffe Hospital (07) 3883 7777
  • Caboolture Hospital (07) 5433 8888

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • Potentially life-threatening symptoms suggestive of:
    • acute upper GI tract bleeding
    • acute severe lower GI tract bleeding
    • oesophageal foreign bodies/food bolus
    • acute Severe Colitis*
    • bowel obstruction
    • abdominal sepsis
  • Severe vomiting and/or diarrhoea with dehydration

*Acute severe colitis as defined by the Truelove and Witts criteria – all patients with ≥ 6 bloody bowel motions per 24 hours plus at least one of the following:

  • temperature at presentation of > 37.8°C,
  • pulse rate at presentation of > 90 bpm,
  • haemoglobin at presentation of < 105 gm/l, CRP >30mg/dl at presentation (or ESR > 30 mm/hr)

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • See other important information for referring practitioners

Category 2

Appointment within 90 days is desirable

  • See other useful information for referring practitioners
  • Polyp surveillance in special circumstances (see other useful information etc)

Category 3

Appointment within 365 days is desirable

  • See other useful information for referring practitioners
  • Routine polyp surveillance (see other useful information etc)

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

NHMRC Clinical Practice Guidelines (2019) recommended screening colonoscopy schedules for polyp surveillance.

  • Colonoscopic surveillance after polypectomy, Cancer Council Guidelines, Cancer Council Australia
  • No sooner than 5 years – If < 5 polyps (excluding diminutive rectosigmoid hyperplastic polyps) provided that all polyps not ‘advanced’ lesions (<10mm in size and no advanced histopathology – no high-grade dysplasia or villous change.
  • 3 yearly – If > 5 polyps (excluding diminutive rectosigmoid hyperplastic polyps) OR if one or more polyps are ‘advanced’ (≥10mm and/or histopathology (presence of high-grade dysplasia or villous change)
  • Annual – If 5 to 9 polyps (excluding diminutive rectosigmoid hyperplastic polyps) IF ANY ADVANCED CHANGES
  • <12 months – If required, a baseline colonoscopy may need to be repeated in cases of poor bowel preparation (immediate rescheduling), possible incomplete excision of a large polyp (often at 3 months) or the presence of multiple adenomas (≥10) to ensure complete clearance

NB: The risk benefit of surveillance should be considered, taking into account, the age and comorbid health of the patient. PATIENTS OVER THE AGE OF 75YRS SHOULD HAVE THE RISK BENEFITS DISCUSSED. SURVEILLANCE IS GENERALLY NOT RECOMMENDED OVER 80YRS.

NB: patients with Familial Adenomatous Polyposis (FAP) and Lynch syndrome (HNPCC) need punctual surveillance due to the high-risk nature of these conditions.

NB: If a patient who has been fully investigated 2 years prior to referral.  Then the referrer and the receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy / colonoscopy procedures

Referral requirements

A referral may be rejected without the following information.

  • Family or personal history of colorectal cancer
  • Relatives diagnosed with FAP
  • Relatives diagnosed with HNPCC
  • Previous endoscopic procedures (date, report and histology)

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander
  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary
  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)