Who is eligible for direct access colonoscopy?

In this service, direct access is for adults aged 45 to 75 with a positive faecal occult blood test, no bowel symptoms, and no significant medical problems affecting sedation. Anyone with bowel symptoms, significant heart, lung, kidney or liver disease, insulin-treated diabetes, or who takes an anticoagulant or two antiplatelet medicines needs a consultation first. This follows the NSW Health direct access colonoscopy model of care.

How soon should a colonoscopy happen after a positive bowel screening test?

The National Bowel Cancer Screening Program performance framework recommends a maximum of 30 days between a positive faecal occult blood test and colonoscopy. A positive faecal occult blood test is also listed as a critical factor in the NSW colonoscopy categorisation, which places such referrals in the most urgent category.

Does direct access colonoscopy cost more?

Direct access removes the initial consultation, so there is no consultation fee for that visit. The procedure itself is charged in the usual way. Public hospital direct access colonoscopy in NSW has no out of pocket cost. In the private system, costs depend on private health cover, and a written estimate is given before anything is booked.

Can I refer myself for a direct access colonoscopy?

No. A referral from a general practitioner or another specialist is needed, both for the clinical information and for a Medicare rebate. The eligibility check on this page is a guide to whether the direct access pathway is likely to suit, not a booking.

What happens if I am not eligible for direct access?

A consultation is arranged first. This is not a delay tactic. It means there is something about the symptoms, the medical history or the medicines that is better sorted out before a bowel preparation and a sedated procedure, rather than on the morning of the test.

Do I need to stop Ozempic or Mounjaro before a colonoscopy?

Current Australian guidance advises against stopping a GLP-1 receptor agonist such as Ozempic, Wegovy, Rybelsus, Trulicity, Victoza, Saxenda or Mounjaro before a procedure. The April 2025 recommendations from the Australian Diabetes Society, ANZCA and the Gastroenterological Society of Australia ask instead for a full day of clear fluids followed by the standard fast, which a routine bowel preparation already provides. Keep taking the medicine, follow the preparation exactly with nothing solid once the clear fluid day begins, and tell the rooms and the doctor that you take it, particularly if a gastroscopy is planned at the same visit.

Do I need to stop my diabetes tablet before a colonoscopy?

Yes. A medicine ending in flozin, such as Forxiga, Jardiance or Steglatro, or a combination tablet such as Xigduo, Jardiamet, Segluromet, Glyxambi, Qtern or Steglujan, should be withheld for three days around a colonoscopy that needs a bowel preparation: the two days before and the day of the procedure. The low carbohydrate intake during bowel preparation can otherwise trigger ketoacidosis, which can occur even when the blood sugar reading looks normal. This advice comes from a joint alert by the Australian Diabetes Society, the Australian Diabetes Educators Association and the colleges of anaesthetists.

Direct Access Colonoscopy Sydney | Eligibility and GP Referral

Q: What is direct access colonoscopy?

Direct access colonoscopy means going straight to the procedure without a separate clinic appointment first. The referral is assessed on paper, the preparation instructions are sent out, and the first time the patient attends is on the day of the colonoscopy. The specialist still meets the patient before and after the procedure. It suits people who are otherwise well and have no bowel symptoms.

Written and reviewed by A/Prof Viraj Kariyawasam, gastroenterologist and hepatologist, MBBS (Hons), FRACP, MRCP (UK), PhD. First published 9 October 2026. Last clinical review October 2026.

Who it is forAdults 45 to 75 with a positive faecal occult blood test and no bowel symptoms.

What it skipsThe clinic appointment before the procedure. Not the consultation on the day.

Still neededA referral from a GP or specialist, and someone to take you home.

TimeframeThe national screening program sets a maximum of 30 days from a positive test to colonoscopy.

What direct access means

In the usual pathway a person sees a gastroenterologist in the rooms, the colonoscopy is discussed and booked, and they come back on another day for the procedure. That is two trips, two sets of time off work, and usually two fees.

Direct access removes the first trip. The referral is assessed on paper against a set of criteria, the bowel preparation and instructions are sent out, and the first time the patient attends is on the morning of the colonoscopy. The specialist still sees them before the procedure to go through the history, the consent and any questions, and again afterwards with the findings. The conversation still happens. It happens on the day rather than weeks earlier.

This is not a shortcut around assessment. It is a different place to do the assessment, and it only works when the assessment can safely be done on paper and by telephone. That is why the criteria below are narrow.

Direct access is not for symptoms

In this service direct access is for a positive bowel screening test in someone who feels well. Rectal bleeding, iron deficiency, a change in bowel habit, weight loss or abdominal pain all need a consultation first. Those symptoms change what the colonoscopy is looking for, what else needs testing and sometimes what happens before it. They are not a reason to wait, they are a reason to be seen.

Why some people need a consultation first

Being told the direct access pathway does not suit is not a knock back and it is not a delay. Every item on that list is there because something about it is better sorted out in a consultation than discovered on the morning of a procedure, after a bowel preparation has already been taken.

Symptoms change the question. A positive screening test in someone who feels well asks one thing: is there a polyp or a cancer to find. Rectal bleeding, iron deficiency or a change in bowel habit ask a wider question, and sometimes a gastroscopy, blood tests or imaging belong in the same plan. Working that out on paper is guesswork.

Heart, lung, kidney and liver disease change the sedation. Colonoscopy here is done under deep sedation given by an anaesthetist. Significant disease in any of those systems changes how that sedation is planned, where it is safe to do the procedure, and occasionally whether a different test is the better answer.

Blood thinners need a plan, not a guess. Stopping an anticoagulant carries its own risk, and so does leaving it running if a polyp needs removing. That decision depends on why the medicine was started, which is a conversation between the gastroenterologist, the prescriber and the patient. Aspirin on its own can usually continue and does not need any of this.

Insulin and bowel preparation interact. A day of clear fluids with usual insulin doses is a recipe for hypoglycaemia. It is manageable, but it needs planning.

If any of these apply, a consultation gets booked instead, and the colonoscopy is arranged from there. For a positive screening test the aim is still to have the colonoscopy within the recommended timeframe.

Two medicines that matter for your safety

Neither of these rules out direct access. Both carry a real risk if they are missed, and both are easy to miss, because many people do not think of them as medicines that matter for a bowel test. Tell the rooms about them when the appointment is made.

Medicines ending in “flozin”

These are taken for type 2 diabetes, and increasingly for heart failure and kidney disease. Examples in Australia include Forxiga (dapagliflozin), Jardiance (empagliflozin) and Steglatro (ertugliflozin), and the combination tablets Xigduo, Jardiamet, Segluromet, Glyxambi, Qtern and Steglujan. That is not a complete list, and the same medicine is sold under other brand names, so the reliable test is the generic name ending in “flozin”. Some people take one without realising it is inside a combination tablet.

A bowel preparation means a day with almost no carbohydrate. In someone taking one of these medicines, that combination can cause ketoacidosis, a dangerous build up of acid in the blood, and it can happen while the blood sugar reading still looks normal. That is what makes it easy to miss.

The Australian advice, from a joint alert by the Australian Diabetes Society, the Australian Diabetes Educators Association and the colleges of anaesthetists, is to stop the medicine for three days around a colonoscopy that needs a bowel preparation: the two days before, and the day of the procedure itself. The last dose is three days before. This is one of the few instructions on this page that is not negotiable.

Ozempic, Mounjaro and the others in that group

These are taken for type 2 diabetes and for weight. Examples in Australia include Ozempic, Wegovy and Rybelsus (semaglutide), Trulicity (dulaglutide), Victoza and Saxenda (liraglutide), and Mounjaro (tirzepatide). Others exist and more keep arriving, so if you take any injection or tablet for diabetes or weight, say so rather than checking it against this list. They slow the stomach down, which is part of how they work, and that raises the question of whether food is still sitting in the stomach when sedation starts.

The instinct is to stop them before a procedure. Current Australian advice is not to. Guidance published in April 2025 by the Australian Diabetes Society with the colleges of anaesthetists and the Gastroenterological Society of Australia recommends against stopping these medicines ahead of a procedure, and asks instead for a full day of clear fluids followed by the standard fast. A standard bowel preparation already builds that clear fluid day in, which is why a colonoscopy sits more comfortably with these medicines than most other procedures do.

Two things still matter. Follow the preparation exactly, with nothing solid once the clear fluid day begins, because the day is doing real work. And say that you take it, both when booking and on the day, particularly if a gastroscopy is being done at the same visit, since that is the combination where the concern is greatest.

Where this advice comes from

Public and private pathways in NSW

Direct access colonoscopy exists in both systems in NSW and works slightly differently in each.

In the public system it is a formal NSW Health programme. Local health districts run direct access colonoscopy services under a statewide model of care published by the Cancer Institute NSW. A specially trained nurse assesses the patient by telephone against local criteria, and eligible patients attend hospital once, on the day. There is no out of pocket cost. Eligibility is generally a person aged 45 to 75 with a positive faecal occult blood test who is asymptomatic and otherwise well, though each district sets its own detail. A GP can find the local service and its criteria through Cancer Institute NSW or the relevant HealthPathways page.

In the private system there is no single standard, and services set their own criteria. Some accept symptomatic patients through direct access. This service does not, and follows the public model of care on that point. Procedures are performed at Norwest Private Hospital, Macquarie University Hospital and Pennant Hills Day Surgery.

Whichever pathway is used, the urgency is the same. A positive faecal occult blood test is a critical factor in the NSW colonoscopy categorisation, and the National Bowel Cancer Screening Program performance framework recommends a maximum of 30 days between a positive test and colonoscopy. If the private wait is longer than the public one in a given area, the public service is the better referral, and the reverse is also true.

A second screening kit is not the answer

Repeating the faecal test after a positive result does not rule anything out. A negative second kit in someone who has already tested positive does not cancel the first result, and the colonoscopy is still needed. There is more on this on the positive screening test page.

For referring doctors

Direct access colonoscopy in this service is for a positive faecal occult blood test in an asymptomatic patient aged 45 to 75 who is otherwise well. The criteria follow the Cancer Institute NSW direct access colonoscopy model of care. Referrals outside the criteria are welcome, they are simply booked as a consultation first rather than straight to a list.

Accepted indication

Positive faecal occult blood test, through the National Bowel Cancer Screening Program or requested in practice. Please attach the result or give the test date and type.

Refer for consultation instead if any of these apply

Any bowel symptom: rectal bleeding, iron deficiency with or without anaemia, change in bowel habit beyond six weeks, unexplained weight loss, recurrent abdominal pain, or a palpable mass
Age under 45 or over 75
Ischaemic heart disease, heart failure, significant valvular disease, pacemaker or implantable defibrillator
Myocardial infarction or stroke within three months
Significant respiratory disease or home oxygen
Insulin-treated diabetes
eGFR under 60
Cirrhosis or advanced liver disease
BMI over 40
Previous adverse event with anaesthesia or sedation
Anticoagulant, or dual antiplatelet therapy, or clopidogrel, ticagrelor or prasugrel. Aspirin alone may continue
Active malignancy under treatment
Previous difficult or incomplete colonoscopy
Any barrier to informed consent, or to a telephone conversation about preparation

Patient safety: two medicines to name on the referral

Neither of these is an exclusion, but both need naming on the referral so the instruction reaches the patient without a consultation to carry it.

SGLT2 inhibitors. Withhold for three days around a colonoscopy requiring bowel preparation, that is the two days before plus the day of the procedure, because carbohydrate restriction with an SGLT2 inhibitor can precipitate euglycaemic ketoacidosis. These brands are examples rather than a register, so the generic stem is the safer check. Worth looking at combination products, where patients often do not know one is included.
GLP-1 and GLP-1/GIP receptor agonists. Current Australian guidance advises against elective pre-procedural cessation. The recommendation is a 24-hour clear fluid diet followed by the standard fast, which a routine bowel preparation already provides. The aspiration signal sits with upper endoscopy and combined upper and lower procedures rather than colonoscopy alone, so flag any patient for whom a same-sitting gastroscopy is likely.

How to refer

Secure electronic referral is preferred, through HealthLink chabelvi or Argus cha, addressed to A/Prof Viraj Kariyawasam. Referrals can also be emailed to the rooms. Please mark the referral clearly as a direct access request so it is triaged to the right pathway, and include the faecal test result, a current medication list naming any SGLT2 inhibitor or GLP-1 receptor agonist, recent blood results and any previous colonoscopy reports and histology.

The referral form below sets out the criteria and the information needed. It is not compulsory. A letter carrying the same information works just as well.

Direct access colonoscopy referral form

A one page PDF with the eligibility criteria, the clinical details needed and where to send it.

Download the referral form (PDF)

Referrals are reviewed by A/Prof Kariyawasam, not by administrative staff. If something on the referral suggests the direct access pathway is not the safest route, the rooms will contact the practice and arrange a consultation instead.

There is more general referral information, including which referrals are prioritised and which tests are worth doing beforehand, on the information for GPs page.

What it costs

Direct access removes the initial consultation, so there is no fee for that visit. The procedure itself is charged in the usual way, and the costs are the same as any other colonoscopy here.

In a NSW public hospital direct access service there is no out of pocket cost at all. Privately, what a person pays depends on whether they hold private health cover and what it covers. A written estimate is always given before anything is booked, which is the informed financial consent step, and nothing proceeds until that has been seen and accepted. There is a fuller explanation on the fees and rebates page.

A current referral from a GP or another specialist is needed for a Medicare rebate.

Where direct access colonoscopy is performed in Sydney

A/Prof Viraj Kariyawasam is a consultant gastroenterologist and hepatologist, recertified in adult colonoscopy. People who do not meet the criteria for this pathway are seen instead in Norwest, Rouse Hill, Pennant Hills and Macquarie Park.

The colonoscopy is performed at Norwest Private Hospital, Macquarie University Hospital and Pennant Hills Day Surgery. A referral from your GP is needed either way.

Direct access colonoscopy in Sydney