High risk clinic for hereditary colorectal neoplasia: a focus for patient care and an opportunity for clinical research

Background

Patients with hereditary colorectal neoplasia and their families need specialized care to plan for appropriate surveillance and to ensure that they receive the most favorable treatment. This involves coordinating multidisciplinary appointments on the same day to minimize inconvenience to patients. We have established a special high risk clinic for these patients and their families. In this study we are reporting our activity for the last 5 years.

Methods

Initially the clinic ran one morning a month but has grown in the last 2 years adding another half day session. Requests for appointments were triaged by registry coordinators. Patients with syndromes of hereditary colorectal neoplasia were eligible for this clinic if the necessary appointments included multiple physicians. The clinic is staffed by one of three colorectal surgeons, one gastroenterologist, one genetic counselor, one hepatobiliary/upper GI surgeon and often by a clinical geneticist.

Results

From January 2004 to November 2008 there have been 440 patient visits (Table 1), 68 colonoscopies, 180 flexible sigmoidoscopies, and 226 EGDs (Table 2), 44 consults to medical genetics were performed, and 9 to general surgery (Table 3). Clinic activity generated 101 surgeries including 37 colectomies and 7 duodenectomies. If all the appointments were done separately this would mean at least 967 separate visits.

Table 1

Table 2

Table 3

Conclusion

The High Risk Clinic is a valuable resource for patients, insurers, and registry workers.