TWO WEEK REFERRAL SERVICES – GI UPPER
Indications for an urgent referral for a suspected new malignancy [National Collaborating Centre for Cancer 2015 guidelines]
Patients with one or more of the following:
Automatic Endoscopy Pathway
GP will be provided with histology results and retains clinical responsibility for the patient should the histology prove benign (if suspicion of cancer patients will be told and will be discussed at MDT).
- Dysphagia – food sticking on swallowing
- Aged 55 and over with weight loss and any of the following
– Upper abdominal pain
- Persistent continuous vomiting
- Haematemesis & Melaena (Upper GI Bleed)
- Dyspepsia with unintentional clinically significant weight loss ( >5% in the last 6 months)
- Upper Abdominal Mass or abnormality on imaging
- Patient has previously been through the Automatic Endoscopy Pathway but symptoms persist
Jaundice Pathway – Obstructive Jaundice
Patient will be offered an appointment in the jaundice clinic
Please note the following exclusions and correct referral route:
Patients with Hb <100 with low Ferritin (iron deficiency anaemia) should be referred using the GI – Lower referral form.
Any patient outside these patient groups should be referred in the usual way to a Consultant. For non-urgent endoscopy referrals please refer as per local policy.
Patients who have previously been through the Automatic Endoscopy Pathway but symptoms persist despite treatment (BD dose of PPI and H2 blocker) after three months should be referred via a routine Gastroenterology Referral.
Consider an urgent direct access CT scan (to be performed within 2 weeks), or an urgent ultrasound scan if CT is not available, to assess for pancreatic cancer in people aged 60 and over with weight loss and any of the following: diarrhoea, back pain, abdominal pain, nausea, and vomiting, constipation or new-onset diabetes.
It is recommended that GP undertakes investigations of FBC, LFTs and Amylase at time of referral. Patients with a negative endoscopy may be referred back to their GP for monitoring, this will be clearly communicated if it occurs, and patients can be directly re-referred back through the 2WW route.
All 2WW referrals should be made through the NHS eReferral Service (previously known as Choose & Book).
Consider giving the patient a 2WW Cancer Research UK information leaflet by following link