Gastroscopy

If clinical concerns but doesn't appear to fit criteria, consider using A&G through ERS.

Urgently refer patients WITH dyspepsia and any of the following:

  • Chronic gastrointestinal bleeding
  • Haematemesis
  • Dysphagia
  • Progressive Unintentional Weight Loss
  • Persistent Vomiting
  • Iron Deficiency Anaemia
  • Epigastric Mass
  • Suspicious Barium Meal Result
  • Aged >55 years with Unexplained and Persistent Dyspepsia Alone

Urgently refer patients WITHOUT dyspepsia and any of the following:

  • Unexplained Upper Abdominal Pain and Weight Loss, with or without Back Pain
  • Upper Abdominal Mass
  • Persistent Vomiting and Weight Loss
  • Iron Deficiency Anaemia
  • Consider urgently referring patients presenting with unexplained worsening dyspepsia and:
    • Barrett's Oesophagus
    • Known Dyspepsia, Atrophic Gastritis or Intestinal Metaplasia
    • Peptic Ulcer Surgery >20 years ago

Significant Weight Loss Only?

Non Site-Specific Pathway

Upper GI

If clinical concerns, but doesn;t appear to fit criteria, consider using A&G through ERS.

Your patient may be invited straight to diagnostic endoscopic test with Dyspepsia and any of the following alarm symptoms:

  • Progressive Unintentional Weight Loss (>10%)
  • Persistent Vomiting (>6 weeks)
  • Age >55 years with unexplained or persistent dyspepsia, reflux, upper abdominal pain (>6 weeks) or during treatment with Proton Pump Inhibitor (PPI)

Your patient will be offered a 2 week wait clinic OPA with any of the following:

  • Upper Abdominal Mass
  • Iron Deficient Anaemia; Iron Deficiency Anaemia Clinic at CRH
  • Suspicious Radiology Imaging

Significant Weight Loss Only?

Non Site-Specific Pathway

Jaundice

For suspected pancreatic cancer, consider direct access urgent GI scan (within 2 weeks).
Isolated raised bilirubin, consider haemolysis; do haemolysis screen (tick haemolysis box on ICE)
If normal, probably Gilbert's syndrome.