Patients with upper GI bleed or other emergencies should be referred via the on call team and not to direct access services.
Please refer via USC/2WW pathways for patients with possible Upper GI cancer or lower GI cancer.
Please submit requests for direct access endoscopy via eRS using one of the generic forms as below (available as templates in EMIS):
Referrals will be seen in clinical priority order. It is important that results of appropriate tests are included (e.g bloods, Coeliac Screen, FIT, Faecal Calprotectin, Helicobacter Pylori stool antigen test) as this will help with the prioritisation of patients. Referrals with incomplete information or not on the correct form may be returned
The current direct access options for referral are as follows and patients will be offered a choice of provider unless otherwise requested:
*Exclusion Criteria for community endoscopy services (exclusion criteria may vary between providers so the list below is only a guide):
The CDC (InHealth) also has the following exclusions:
*Please see the InHealth Service guide for full list of exclusions
For community colonoscopy patients should also be:
Patients who do not fulfil criteria for USC/2WW or Direct access endoscopy may need to be referred to secondary care. However, NBT and UHBW do not accept direct referrals for endoscopy. If a patient does not meet criteria for USC/2WW or a direct access referral then please consider the following options:
Additional Support for Endoscopy UHBW
If patients have additional needs eg Autism, Learning Disabilities, Mental health issues and Dementia there is a Care Navigator for endoscopy at UHBW (Trudy.Reed@uhbw.nhs.uk) who will support patients to understand and undertake their procedure. This is only available for patients who are under the care of UHBW and therefore GPs cannot refer directly from primary care.
Please see the Coeliac disease page for advice on investigation of possible coeliac disease.
If duodenal biopsy is required to confirm a diagnosis, then refer via eRS for direct access endoscopy using the BNSSG upper GI endoscopy form (also available in EMIS).
The following providers offer a duodenal biopsy service:
Patients must be eating a diet containing gluten.
For patients who do not meet criteria or are excluded from a direct access service, then please consider the secondary care options as listed above.
PEG insertions at UHB can be requested on ICE - search for Upper GI OG Waiting List Form.
For practices that do not have access to ICE please refer directly to Queens Day Unit on their Upper GI referral proforma.
PEG insertions/removals/replacement in adults at NBT can be requested by emailing an urgent referral to: gastroenterologyandhepatologysecretaries@nbt.nhs.uk they will be triaged by the ward consultant. The procedure will be booked on your behalf; however, please ensure the patient’s capacity to consent is documented on the referral.
If the patient lacks capacity to consent, please could the outcome of best interest discussions be included in the referral.
Please note that Gastrostomy A&G is available from NBT. See the Gastro A&G page for further details.
PEG insertions should be requested on the referral form and emailed to wnt-tr.endoscopybookingteam@nhs.net where they will be sent for triage. A patient information leaflet is also available.
The attached information leaflet has been produced by Nutricia and is aimed specifically at GPs who may be asked to make decisions about feeding through PEG tubes that are potentially buried, and to make emergency referrals for PEG change before the problem progresses.
Patients with a known benign oesophageal stricture who start to experience recurrent symptoms should be referred via eRS (or letter directly to consultant if previously advised) to the hospital department where they were originally seen if possible. (Please see update below for most recent position regarding urgency of referral). They will need to be reviewed in an outpatient clinic (face to face or remotely) to discuss suitability for further dilatation before this can be booked. Occasionally, patients who need frequent dilatations may have access to patient initiated follow up where this is appropriate and previously agreed.
If a patient presents with dysphagia, upper abdominal mass or weight loss and malignancy needs to be excluded then an Upper GI - USC (2WW) Referral should be considered instead.
Patients with strictures should not be referred to direct access endoscopy services (CDC or PPG/EGTC) as these providers are unable to carry out dilatation procedures.
Please see the Barrett's Oesophagus page.
Sedation
Discussions around sedation are best had with the patient and an endoscopy nurse or endoscopist and not with the GP. Patients requesting sedation for endoscopy should be advised that this will be discussed with the endoscopist prior to their procedure.
The community diagnostic centre (CDC) also advises the following:
'Some patients may be able to tolerate a trans nasal endoscopy better than a traditional OGD which could be done with or without sedation at the CDC. For some patients who are frail, it is unsafe to give any sedation and always ultimately down to the endoscopist to decide (with discussion with the patient). This would be true wherever they attend for endoscopy.'
Referrers should therefore refer in the usual way and should avoid stating that a patient needs deep sedation as this can cause confusion.
If further advice is required on appropriateness of community endoscopy for an individual patient then please consider requesting gastroenterology advice and guidance or refer to the community gastroenterology clinic.
You can also contact the community providers using the contact details in the section below.
General Anaesthetic
As detailed above, community endoscopy providers can generally give just as deep a sedation as secondary care providers. The only difference is that community services cannot give propofol or General Anaesthetic.
GA or propofol is only available in secondary care and is only necessary for complex therapeutic procedures (these are not referred from primary care) or for patients with severe learning difficulties where ability to cooperate during a procedure is in doubt.
If uncertain about need for GA then please request gastroenterology advice and guidance initially.
Referrals requesting endoscopy under sedation or GA sent to secondary care may be returned with the above advice.
Referrers can contact the lead endoscopist to discuss referrals on the following numbers:
Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.