Direct access upper GI endoscopy

Harrogate and District NHS Foundation Trust

Definition/Description

Direct Access Upper GI endoscopy

Red Flag Symptoms

See suspected upper GI cancer pathway

Guidelines on Management

NICE non-urgent criteria to exclude cancer

  • Haematemesis
  • People aged 55 or over with:
    • treatment-resistant dyspepsia (see 2) 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**

Reflux symptoms

  • Lifestyle advice and offer full dose of PPI for 4-8 weeks
  • If symptoms recur after initial treatments:
    • use lowest dose possible of PPI
    • offer H2RA therapy if idequate response to PPI
  • If response adequate no need for endoscopy. Proceed to open access upper GI endoscopy only if inadequate response.

Non Reflux/dyspepsia symptoms

Lifestyle advice, review medication (e.g. NSAID). Offer one of:

  • 1 month trial of PPI
    OR
  • H Pylori Testing: Use stool antigen test Leave a 2 week washout period after PPI
    • H pylori positive and symptomatic
      • Eradication therapy – see NICE/CKS/BNF
      • Still symptomatic - retest with stool antigen test (ideally 4-8 weeks post-treatment)
      • Second line therapy – see NICE/CKS/BNF. Aim to use antibiotics patient not previously exposed to
    • H pylori not known or negative but still symptomatic
      • Empirical full dose PPI for 4 weeks OR If H.Pylori not yet tested and trial of PPI unsuccessful, test for H.Pylori
  • If response adequate no need for endoscopy. Proceed to open access upper GI endoscopy only if inadequate response.

Other indications

Urgent +/- OPA:

  • Persistent vomiting
  • Previous complicated ulcer
  • Previous gastric ulcer
  • Continuing need for NSAIDS

Routine

  • IDA if does not meet 2ww criteria
  • Suspected malabsorption
     
*weight loss in over 55 with reflux or dyspepsia or upper abdo pain = 2ww referral
**Upper abdominal pain in absence of weight loss may require routine abdominal imaging (U/S) and/or upper GI endoscopy if persistent and unexplained

Referral Criteria/Information

Consider for patients who do not meet the criteria for upper GI USC referral and meet the following criteria:

  1. Meet NICE non-urgent criteria to exclude cancer (ensure patients do not otherwise meet full USC guidance)
  2. Treatment failure (see 'guidelines on management' section) in reflux or dyspepsia any age
  3. Other indications
NB: If patient has had a previous endoscopy in the last 3-5 years with non-reflux symptoms, no new pattern of symptoms and no new alarm signs then base management on previous endoscopic findings and consider H pylori testing

Associated Policies

There are no associated policies.

Specialties

Gastroenterology & Hepatology North Yorkshire Urgent Suspected Cancer North Yorkshire

Places covered by

  • North Yorkshire

Hospital Trusts

  • Harrogate and District