Urgent (two week wait)
Referral

Non urgent referral for direct access upper GI endoscopy

How to refer

Dysphagia

2week wait proforma – Suspected Upper GI cancer

Aged 55 or over with weight loss and any of the following:

• Upper abdominal pain
• Reflux
• Dyspepsia

2week wait proforma – Suspected Upper GI cancer

Aged 55 or over with any of the following:

• Treatment resistant dyspepsia
• Upper abdominal pain with low haemoglobin levels
• Raised platelet count with any of the following :-
  • Nausea
  • Vomiting
  • Weight Loss
  • Reflux
  • Dyspepsia
  • Upper Abdominal Pain
• Nausea or vomiting with any of the following :-
  • Weight loss
  • Reflux
  • Dyspepsia
  • Upper Abdominal Pain

Providers will make a judgement on whether patient is fit for procedure, based on medical history detailed in referral.

If patient unfit, provider will organise appointment with gastroenterologist

Non-Urgent Direct Access Upper GI Endoscopy referral form

Aged less than 55 years with treatment resistant dyspepsia, patient requests endoscopy despite reassurance.

Non-Urgent Direct Access Upper GI Endoscopy referral form