Upper GI endoscopy
If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- Potentially life-threatening symptoms suggestive of:
- acute upper GI tract bleeding (bright red blood, PR bleeding, melena, hematemesis)
- acute severe lower GI tract bleeding
- Oesophageal foreign bodies/food bolus
- Displaced gastrostomy tube
Minimum referral criteria
All requests are categorised using state‑wide urgency criteria
Category 1 - Seen within 30 days |
Concerning features
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Category 2 - Seen within 90 days | Dyspepsia/heartburn/reflux with significant, unexplained, persistent, or recent-onset symptoms (treatment-resistant) in the absence of concerning features:
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Category 3 - Seen within 365 days |
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concerning featuresInformation for upper GI endoscopy referrals
Include the standard information and condition-specific information.
Standard information for all referrals
Reason for request
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for general practitioner or second opinion
- For a specified test or investigation the general practitioner can't order, or the patient can't afford or access
- Reassurance for the patient or family
- For other reason (e.g., rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
Patient's demographic details
- Full name (including aliases)
- Date of birth
- Residential and postal address
- Phone contact numbers – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and Torres Strait Islander
Referring practitioner details
- Full name
- Full address
- Contact details – phone, fax, email
- Provider number
- Date of referral
- Signature
- Patient's usual general practitioner (if different from above)
Relevant clinical information about the condition
- Inclusion of Clinical Prioritisation Criteria (CPC) where relevant
- Presenting symptoms (evolution and duration)
- Physical findings
- Investigations carried out and results as indicated in the relevant pathway
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Options already pursued
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
Clinical modifiers
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living
- Impact on ability to care for others
- Impact on personal frailty or safety
- Identifies as Aboriginal and Torres Strait Islander
Other relevant information
- Willingness to have surgery (where surgery is a likely intervention)
- Choice to be treated as a public or private patient
- Compensable status (e.g., DVA, WorkCover, motor vehicle insurance)
Essential information for upper GI endoscopy referrals
- General referral information
- Symptom profile:
- difficulty or pain on swallowing
- food or liquids are stuck in throat or chest
- pain or pressure in chest associated with swallowing
- loss of appetite/food avoidance associated with swallowing difficulty
- Personal and family history of gastrointestinal cancer
- Previous endoscopic procedures (date, report and histology)
- ELFT, FBC, iron studies results
- Relevant imaging reports
Additional information for upper GI endoscopy referrals
- H pylori results (if indicated)
- Coeliac disease serology results (if indicated)
- Past history Barrett's or fundic gland polyps
- Atopy
Anticoagulants
There is no need to stop any anticoagulant before an endoscopy procedure. The endoscopist will decide to intervene or recall the patient, if something is found during the procedure.
Forms
Complete the Endoscopy Referral Form (Rockhampton "Straight to test" requests only) and send via secure messaging. If unable to attach investigations or use secure messaging, see alternative contact details.
Print the Adult Integrated Pre‑screening Tool for the patient to complete and either:
- bring to the appointment.
- fax it with referral form.
Information for your patient
Expected time frame for appointment notifications
- Once the request is received, categorisation by the hospital will occur.
- General practitioners and patients are notified of the assigned category between 14 days to 1 month after completed request is received.
- Patients are usually notified of the upcoming appointment time and date approximately 4 weeks prior unless short notice appointments become available.
Appointment information
- Patients will be given an appointment via phone, SMS, or letter.
- The patient must contact the hospital to reschedule if they are not able to attend.
- If the patient fails to respond to 2 appointment offers:
- They will be discharged back to their general practitioner.
- They can have a new request for assessment sent to the hospital if the need still exists.
- The patient's first appointment may not always be with a specialist. Where appropriate, the request may be sent to a public allied health or nursing service for initial assessment and management. A specialist assessment may then be arranged or ruled out.
Ask your patient to:
- take a list of current medications, and all relevant radiology films and reports to appointments.
- advise of any change in circumstance (e.g., getting worse or becoming pregnant), as this may affect the request for assessment.
- update their contact details (e.g., phone number and address) with the hospital.
Last updated: 24 January 2020
