Rapid Access Endoscopy (RAE) 

What is Rapid Access Endoscopy?

Rapid Access Endoscopy (gastroscopy or colonoscopy) is a streamlined and cost-effective service that allows patients access to care without prior specialist consultation.

For patients with a private health fund, RAE can be performed within two weeks of referral from a GP or specialist. It is performed by a gastroenterologist specialising in diagnosing and treating digestive disorders.

Who Is Eligible For Rapid Access Endoscopy?

Patients suitable for Rapid Access Endoscopy include patients who are:

• Under 80 years of age,
• Using limited or no medications, and not on blood thinners (apixaban, rivaroxaban, dabigatran, warfarin, clopidogrel, prasugrel, ticagrelor) or certain diabetic medications
• Have no significant health issues, and 
• Are in good health (no flu or colds within the previous six weeks)

If you want to be considered for Rapid Access, please forward us your GP or Specialist referral for clinical review.

Rapid Access Suitability

There are many situations where an earlier appointment could be scheduled to fast-track appropriate care. We encourage parents to mention the following to our administration staff to help prioritise an appointment:

Cancer screening or polyp surveillance

Bowel (colon) cancer screening is now recommended to commence from the age of 45 years. Colonoscopy is an excellent method for bowel cancer screening or if you have a positive stool test (FOBT). Patients with polyps removed previously may need a surveillance colonoscopy. Rapid access colonoscopy is an efficient way of investigating with reduced costs.

Positive Coeliac Serology:

Coeliac Disease, or having a positive blood test for the coeliac disease, could be stressful. Going gluten-free before gastroscopy may confuse the diagnosis. 

Those children on a gluten-reduced/free diet may have to go on a formal gluten challenge for at least 6-8 weeks before an endoscopy. To avoid these situations, an earlier appointment could be prioritised.

Elevated stool calprotectin and suspected inflammatory bowel disease:

Inflammatory bowel disease (Crohn’s Disease and Ulcerative colitis) is a chronic inflammatory condition of the gastrointestinal tract. A stool calprotectin is an excellent screen for such conditions. However, there are many other situations where it could be raised. Those children with raised stool calprotectin are recommended to have an earlier appointment to investigate the cause further.

Dysphagia (swallowing difficulties):

Eosinophilic oesophagitis (choking on food): Children with dysphagia (swallowing difficulties) may have an oesophageal pathology such as Eosinophilic oesophagitis, an inflammatory condition caused by an allergy to certain foods or environmental triggers. Confirmation of diagnosis and treatment is recommended, as delay in diagnosis and treatment may result in oesophageal narrowing.

Who is Not Suitable for RAE?

Patients not suitable for Rapid Access Endoscopy include patients who are:

• Patients are aged 80 or over.
• Unstable or acutely bleeding patients 
• Have a contraindication to endoscopy, such as known or suspected perforation, severe or acute diverticulitis, fulminant colitis, uncorrectable coagulopathy or thrombocytopenia, or unstable cardiac or pulmonary conditions.
• Patients requiring advanced interventional endoscopic procedures (ERCP, RFA, EMR, and ESD).

Benefits of Rapid Access Endoscopy

• timely diagnosis and treatment of cancer or other digestive disorders, which can lead to a better prognosis and a higher chance of successful treatment
• no specialist consultation is required, meaning less impact on work or busy schedules
• peace of mind for patients who may be anxious about their symptoms
• less invasive and less expensive option than surgery 

Overview of Rapid Access Endoscopy

Before Rapid Access Endoscopy

Preparation for the RAE procedure begins several days before the scheduled procedure. 

• You must follow a clear liquid diet, which includes water, broth, apple juice, and gelatin, for at least 24 hours before the procedure. 
• You must take a prescribed laxative the day before the procedure to help empty the colon. 
• You should avoid solid food, milk, and dairy products on the day of the procedure. 
• You should also inform your gastroenterologist of any medications you are taking, including over-the-counter medications and supplements, as they may need to be adjusted or temporarily discontinued.

During Rapid Access Endoscopy

RAE usually takes 30-60 minutes to complete.

• Anaesthesia: During the procedure, you will receive sedation to help them relax and be comfortable during the test. The sedation is usually an intravenous injection and will be administered by the doctor or anesthesiologist.
• Insertion of Gastroscope and/or Colonoscope: Once the patient is sedated, the doctor will insert the gastroscope through the mouth or colonoscope through the rectum and into the colon. The gastroscope or colonoscope is a flexible tube with a camera at the end that enables the doctor to visualise the inside of the digestive tract.
• Biopsy or Removal of Abnormal Tissue: If the doctor identifies any abnormalities, such as polyps or tumours, you may take a biopsy or remove the abnormal tissue using specialised instruments passed through the gastroscope or colonoscope. The biopsy or removal of tissue is a quick and painless procedure.
• Completion of the Procedure: Once the doctor has completed the examination and taken any necessary biopsies or removed any abnormal tissue, you will slowly withdraw the gastroscope or colonoscope. The entire procedure usually takes between 30 and 60 minutes to complete.

After Rapid Access Endoscopy

• After the procedure, you will be monitored in a recovery area until the sedation wears off. 
• You should arrange for someone to drive them home, as the sedation can impair judgement and reflexes. 
• Feeling cramping, bloating, or gas after the procedure is normal, but these symptoms should subside within a few hours. 
• You can resume your regular diet and activities after the procedure but should avoid driving, operating heavy machinery, or making important decisions for the remainder of the day. 
• The gastroenterologist will discuss the procedure's results. If a biopsy is taken, you will receive instructions on how to care for the biopsy site.

Post-Operative Care Plan

To ensure a successful and safe recovery after the RAE procedure, you should follow these post-operative care instructions:

• Rest: Rest and relax for the remainder of the day after the procedure, and avoid strenuous activities or exercise for at least 24 hours.
• Diet and Hydration: You can resume your regular diet and activities after the procedure. Drink plenty of fluids to stay hydrated and prevent constipation. Alcohol and caffeine should be avoided for at least 24 hours after the procedure.
• Medications: Follow your doctor's medication instructions. If a biopsy was taken during the procedure, you might be prescribed medication to prevent infection or reduce inflammation.
• Watch for Symptoms: Monitor for unusual symptoms such as fever, abdominal pain, bleeding, or difficulty breathing.
• Follow-Up Appointment: Schedule a follow-up appointment with your gastroenterologist to discuss the procedure's results and any necessary treatment or further testing.

Rapid Access Endoscopy Risks

Risks of gastroscopy or colonoscopy are uncommon. Your doctor will discuss the risks with you before the procedure.

• Bleeding: Bleeding is usually mild and stops within a few hours. In rare cases, however, bleeding may be severe and require further medical intervention.
• Perforation: A tear or puncture in the colon wall is a rare but serious complication of RAE. The risk of perforation is higher in patients with underlying medical conditions such as diverticulitis or inflammatory bowel disease. If a perforation occurs during the procedure, the patient may require surgery to repair the damage.
• Infection: A rare but possible complication of RAE. The risk of infection is higher in patients with compromised immune systems or underlying medical conditions such as diabetes. 
• Adverse Reaction to Sedation: Patients who receive sedation during the RAE procedure may experience adverse reactions to the medication. These reactions can include nausea, vomiting, dizziness, or difficulty breathing. You should inform your doctor if you have had adverse reactions to sedation in the past.
• Other Risks: Damage to nearby organs, aspiration of stomach contents into the lungs, or adverse reaction to the bowel prep medication.

What if Rapid Access Endoscopy is Delayed?

You should communicate with your doctor if RAE is delayed due to scheduling issues or unforeseen circumstances. Delaying the procedure can increase the risk of complications or the progression of any abnormalities found during the procedure. It can also lead to a missed or delayed diagnosis of colon cancer or other serious conditions.