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Upper GI Endoscopy

ADULT

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)

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

  • 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 catergory

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • 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

3. Additional referral information Useful for processing the referral

  • H pylori results (if indicated)
  • Coeliac disease serology results (if indicated)
  • Past history Barrett’s or fundic gland polyps
  • Atopy

4. Request

Patient's Demographic Details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

  • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

  • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

 

Version: 8
Last updated: 06 February 2020

© State of Queensland (Queensland Health) 2021

Except as permitted under the Copyright Act 1968, no part of this work may be reproduced, communicated or adapted without permission from Queensland Health. To request permission email ip_officer@health.qld.gov.au.

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