Endoscopy Direct Access
Referral Form
The referral form appearing on this page is for all Leeds referrals, (not just those made at SJUH, LGI or Wharfedale).
Upper GI – Symptoms and Management Options
Indication |
Urgent (two week wait) |
Non urgent referral for direct access upper GI endoscopy |
How to refer |
Dysphagia |
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2week wait proforma – Suspected Upper GI cancer |
Aged 55 or over with weight loss and any of the following:
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2week wait proforma – Suspected Upper GI cancer
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Aged 55 or over with any of the following:
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If patient unfit, provider will organise appointment with gastroenterologist |
Non-Urgent Direct Access Upper GI Endoscopy referral form
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Aged less than 55 years with treatment resistant dyspepsia, patient requests endoscopy despite reassurance. |
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Non-Urgent Direct Access Upper GI Endoscopy referral form |