Gastroenterology

Direct Access Gastroscopy

As we are currently dealing with the COVID 19 crisis, we will not be able to offer a Direct to test 2WW Upper Endoscopy service as normal. Patients referred via this service will need to be assessed on a case-by-case basis. We need to triage referrals and reserve endoscopic procedures for those judged to be of the highest priority.

To help this decision making please can you ensure enough clinical details about symptoms and comorbidities are submitted with the referral.

GPs can request direct access gastroscopy without the patient being seen in outpatients first. This can be a routine or urgent referral at RCHT. It is the GPs responsibility to review the findings. However, all histology will be reviewed by a Consultant Gastroenterologist and clinically significant findings requiring secondary care management e.g. Barrett's oesophagus and Coeliac disease will be identified and booked an outpatient appointment without the need for a further GP referral.

If Coeliac disease is suspected in primary care, please refer patients to Gastroenterology outpatients in the first instance and not for direct access gastroscopy.

If the GP is suspecting oesophageal cancer there are three 2ww pathways available:

• 2ww direct access gastroscopy. For patients 55 and over with dysphagia or a history of weight loss AND reflux/upper abdominal pain/dyspepsia.
• 2ww direct access barium swallow. This is requested using the upper GI cancer 2ww form. For patients with dysphagia above the level of the suprasternal notch. All cancer findings will be automatically discussed at the upper GI cancer MDT. It is the GP's responsibility to review all non cancer findings on barium swallow.
• Upper GI cancer 2ww clinic. If direct access gastroscopy is not appropriate or refused