Upper GI 2ww Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

REFERRAL GUIDELINES FOR SUSPECTED UPPER GASTROINTESTINAL CANCER (All patients will be seen within 2 weeks of referral)

  • Refer a patient who presents with symptoms suggestive of upper gastrointestinal cancer as detailed in the NICE guidance below.
  • H. pylori testing should not affect the decision to refer for suspected cancer
  • Only refer when patient is available to attend an appointment within the next 14 days.

Assessment

  • These cancers have poor prognosis and tend to be diagnosed late, so use safety netting
  • Check FBC and platelets (please note thrombocytosis itself carries a higher risk of positive predictive value), eGFR, LFTs at initial presentation
  • H. pylori testing should not affect the decision to refer for suspected cancer
  • Consider direct access urgent CT scan for suspected pancreatic cancer
  • Consider an urgent direct access ultrasound scan to assess for gall bladder or liver cancer in people with an upper abdominal mass consistent with an enlarged gall bladder or liver.

PLEASE CONSIDER DIRECT ACCESS TO UPPER GI ENDOSCOPY IF APPROPRIATE

IRON DEFICIENCY ANAEMIA WITHOUT DYSPEPSIA – PLEASE REFER USING SUSPECTED LOWER GI CANCER REFERRAL FORM

Please refer to NICE referral guidelines for suspected cancer

Referral

Referral Criteria

Dysphagia

  • Refer for urgent upper GI endoscopy if:
  • age 55 and over with significant weight loss* AND any of the following:
    • Upper abdominal pain
    • Reflux
    • Dyspepsia
  • *significant weight loss: more that 5% body weight in 6 months
Pancreatic Cancer
  • Consider an urgent direct access CT scan, 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
    • vomiting
    • constipation
    • new-onset diabetes

Stomach Cancer

  • Consider non-urgent direct access upper gastrointestinal endoscopy to assess for stomach cancer in people with haematemesis.
  • Consider non-urgent direct access upper gastrointestinal endoscopy to assess for stomach cancer in people aged 55 or over with:
    • treatment-resistant dyspepsia or
    • upper abdominal pain with low haemoglobin levels or
    • raised platelet count with any of the following:
      • nausea
      • vomiting
      • weight loss
      • reflux
      • dyspepsia
      • upper abdominal pain, or
    • nausea or vomiting with any of the following:
      • weight loss
      • reflux
      • dyspepsia
      • upper abdominal pain.

*Creutzfeldt-Jakob Disease:

  • The CJD/CJDv risk assessment form should be completed for all patients undergoing endoscopy procedures and the outcome documented on the fast track referral form

Referral Instructions

Supporting Information

Assurance & Governance

  • This guidance was developed on: 05.2017
  • This guidance was ratified by: OSCAR Assurance Group
  • Date ratified: 05.2017
  • Publication Date: 05.2017
  • Review Date: 05.2019
  • Ref No: CA11 – 05.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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