Patients generally prefer services that are close to home and easily accessible. Thus high-volume
screening endoscopy is probably best situated closer to the population to be screened. In contrast,
level 3 and 4 expertise for removing high-risk lesions is likely to be provided at district and regional
levels respectively. The priority here is the facility and expertise, not proximity.
When implementing high-volume screening endoscopy consideration should be given to locating services
in convenient locations for patients to maximise engagement in screening
Possible destabilising effect on symptomatic services
Unplanned introduction of screening endoscopy (at whatever level) creates additional demand and
may lead to destabilisation of the symptomatic service. Thus, if endoscopy for screening is introduced
alongside symptomatic services, care must be taken to ensue there is sufficient new capacity.
An assessment of the impact of demand from screening on waiting times for symptomatic patients
should be made to ensure that there is sufficient planned new capacity such that screening does not
lengthen waits for symptomatic patients
Infrastructure and efficiency
The infrastructure requirements for high-volume screening endoscopy need to cater to large numbers
of presumptively healthy people. High-volume screening endoscopy requires efficient booking, assessment
and recovery processes to function effectively without compromising the patient experience.
Thus, it may be advantageous for high-volume screening activities to be separated from routine clinical
endoscopy and follow-up endoscopy of screen-positives.
