Upper GI Endoscopy

Emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

Upper GI endoscopy

  • Potentially life-threatening symptoms suggestive of:
    • acute upper GI tract bleeding (bright red blood, PR bleeding, melena, hematemesis)
    • acute severe lower GI tract bleeding
  • Oesophageal foreign bodies/food bolus
  • Displaced gastrostomy tube 

Colonoscopy

  • Potentially life-threatening symptoms suggestive of:
    • acute severe colitis*
    • bowel obstruction
    • abdominal sepsis
  • Severe vomiting and/or diarrhoea with dehydration

*Acute severe colitis as defined by the Truelove and Witts criteria – all patients with ≥ 6 bloody bowel motions per 24 hours plus at least one of the following:

  • Temperature at presentation of > 37.8°C,
  • Pulse rate at presentation of > 90 bpm,
  • Haemoglobin at presentation of < 105 gm/l, CRP >20mg/dl at presentation (or ESR > 30 mm/hr)
Useful Management Information

NB: If a patient who has been fully investigated 2 years prior to referral.  Then the referrer and the receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy / colonoscopy procedures.

Surveillance

  • Barrett’s surveillance
  • Oesophageal varices surveillance in patients who have never bled
  • Genetic cancer surveillance i.e lynch syndrome, familial adenomatous polyposis (FAP), hereditary nonpolposis colorectal cancer (HNPCC)

Clinical guidelines

Patient information

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)

  • For optimal care, patients should be seen within 1 week:
    • suspected GI cancer on clinical examination or abnormal imaging
    • dysphagia with poor oral intake
  • Significant dysphagia
  • Dyspepsia/heartburn/reflux with significant, unexplained, persistent, or recent-onset symptoms (treatment-resistant) with the presence of concerning features
  • Severe abdominal pain with presence of concerning features or significant impact on activities of daily living
  • Anaemia or iron deficiency with no obvious cause and/or persisting despite correction of potential causative factors and /or presence of concerning features

Presence of concerning features

  • Gastrointestinal bleeding
  • Weight loss, ≥5% of body weight in previous 6 months
  • Difficulty swallowing
  • Persistent vomiting
  • Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women
  • Persistent abdominal pain
  • Abdominal mass on clinical examination or abnormal imaging
  • Patient and family history of Barrett’s, oesophageal or gastric or bowel cancer
    iFOBT or calprotectin +ve
Category 2
(appointment within 90 calendar days)
  • Dyspepsia/heartburn/reflux with significant, unexplained, persistent, or recent-onset symptoms (treatment-resistant) in the absence of concerning features

Absence of concerning features

  • Gastrointestinal bleeding
  • Weight loss, ≥5% of body weight in previous 6 months
  • Difficulty swallowing
  • Persistent vomiting
  • Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

If your patient does not meet the minimum referral criteria

  • Consider other treatment pathways or an alternative diagnosis
  • If you still need to refer your patient:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
    • Please note that your referral may not be accepted or may be redirected to another service

Essential referral information

Without this information the referral will be returned

  • Symptom profile:
    • difficulty or pain on swallowing
    • food or liquids are stuck in throat or chest
    • pain or pressure in chest associated with swallowing
    • loss of appetite/food avoidance associated with swallowing difficulty
  • Personal and family history of gastrointestinal cancer
  • Previous endoscopic procedures (date, report and histology)
  • BMI
  • ELFT, FBC, iron studies result
  • Relevant imaging reports
Additional Referral Information
  • Serial FBC results (if available)
  • History of alcohol and drug use
  • History of menorrhagia
  • CRP, Coombs test or haptoglobin results
Clinical Override

Clinical override of referral criteria may be requested in the following situations:

  • Inability to include essential referral information. If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons.
  • Patient does not meet minimum referral criteria. If the patient does not meet the criteria for referral but the referring practitioner believes that the patient requires specialist review.
  • Presence of clinical modifiers. The presence of clinical modifiers (as listed above in Standard referral information) may impact on the categorisation of a patient.

Include the reason for request for clinical override as part of the referral. Referrals are reviewed by the triaging specialist who determines the most appropriate course of action.

Out of catchment

West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.

Feedback

To provide feedback about contents on this website or general referral questions please email WM-CPC@health.qld.gov.au or phone 3413 7402.