Direct Access Gastroscopy

GPs can request direct access gastroscopy without the patient being seen in outpatients first. This can be a routine or urgent referral at RCHT. It is the GPs responsibility to review the findings. However, all histology will be reviewed by a Consultant Gastroenterologist and clinically significant findings requiring secondary care management e.g. Barrett's oesophagus and Coeliac disease will be identified and booked an outpatient appointment without the need for a further GP referral.

Patients with suspected coeliac disease can be referred for direct access gastroscopy + biopsy. All patients require a gluten containing diet for at least 4 weeks prior to biopsy. If the patient is frail or not willing to undertake an OGD, please refer to clinic first where a decision can be made either to undergo endoscopy or to recommend a gluten free diet without biopsy.

If the GP is suspecting oesophageal cancer there are three 2ww pathways available:

2ww direct access gastroscopy. For patients with dysphagia or patients aged 55 and over with a history of weight loss AND reflux/upper abdominal pain/dyspepsia.
2ww direct access barium swallow. This is requested using the upper GI cancer 2ww form. For patients with dysphagia above the level of the suprasternal notch. All cancer findings will be automatically discussed at the upper GI cancer MDT. It is the GP's responsibility to review all non cancer findings on barium swallow.
Upper GI cancer 2ww clinic. If direct access gastroscopy is not appropriate or refused