Gastroscopy (Direct Access) - Adult
Gastroscopy (Direct Access) - Adult
Emergency and immediate referrals
Referral to Emergency Department
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region:
- Significant acute upper GI bleeding (e.g. haematemesis, melaena)
Immediately contact the on-call registrar or service to arrange an immediate gastroenterology assessment (seen within 7 days) for:
To contact the relevant service, please see Clinician Assist WA: Acute Gastroenterology Assessment
Clinical indications for outpatient referral |
- Unexplained iron deficiency +/- anaemia with no identified cause and/or unresponsive to treatment
- Unexplained recent dyspepsia AND in presence of alarm symptoms*
- Non-responsive GORD (following 6-8 weeks of double dosage PPI treatment)
- Persistent or recurrent (≥4 weeks) dysphagia
- Mass or abnormal imaging
- Upper abdominal pain AND unexplained weight loss (>10%) OR abnormal blood test (low Hb, Low ferritin, microcytosis, hypochromia, raised platelets)
- Persistent nausea/vomiting AND unexplained weight loss (>10%) OR abnormal blood test (low Hb, Low ferritin, microcytosis, hypochromia, raised platelets)
- Suspected Coeliac disease with positive serology
- Known Coeliac disease with no exposure to gluten AND persistent high titres after 12 months OR persistent alarm symptoms*
- Pernicious anaemia (serologically diagnosed) asymptomatic at time of diagnosis
- Surveillance procedures required within 12 months
- Surveillance requested by previous Endoscopist
*Alarm Symptoms:
- Gastrointestinal bleeding
- Unexplained progressive weight loss
- Unexplained iron deficiency anaemia
- Dysphagia
- Early satiety
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Mandatory referral information (referral will be returned if this information is not included) |
- Reason for referral:
- At least one indication must be ticked under the following
sections, or an adequate description provided:
- Medical history, risk factors and current medications list including:
- Weight – if exact weight is not known an estimate must
be provided
- Indicate if the patient has cardiac
stents/pacemaker/implanted defibrillator (if history of heart disease)
- List of anti-coagulation medications, and the indication for prescription
- Evidence to support reason for referral must be attached e.g.
- Length of time and/or number of episodes for GI bleeding
- Description of bowel habit changes
- FBC and Ferritin results for unexplained iron deficiency anaemia
- Imaging
- Weight loss %
- U&Es for patients with kidney disease
- LFTs/INR/Platelets for patients with liver disease
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Highly desirable referral information |
- Results of any additional tests that have been undertaken as part of referral decision
- Results of any previous gastroscopy
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Feedback
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Indicative clinical urgency category
Indicative clinical urgency category |
Category 1
Appointment within 30 days |
- Unexplained iron deficiency +/- anaemia in men or non-menstruating women and the presence of alarm symptoms
- Unexplained recent dyspepsia, age ≥45 and the presence of alarm symptoms
- Non-responsive GORD (following 6-8 weeks of double dosage PPI treatment) and the presence of alarm symptoms
- Dysphagia, persistent or recurrent (≥4 weeks)
- Mass/abnormal imaging, likely oesophageal or gastric cancer
- Upper abdominal pain or persistent nausea/vomiting, age ≥45 years and unexplained weight loss (>10%) or abnormal blood test
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Category 2
Appointment within 90 days |
- Unexplained iron deficiency +/- anaemia with no obvious cause and/or unresponsive to treatment.
- Unexplained recent dyspepsia, age <45 and the presence of alarm symptoms
- Dyspepsia (≥45) AND non-responsive to PPI and/or H. pylori therapy or H. pylori negative.
- Non-responsive GORD (following 6-8 weeks of double dosage PPI treatment)
- Upper abdominal pain or persistent nausea/vomiting, age <45 years and unexplained weight loss (>10%) or abnormal blood test
- Suspected Coeliac disease with positive serology
- Known Coeliac disease with no exposure to gluten and persistent high titres after 12 months or persistent alarm symptoms
- Pernicious anaemia (serologically diagnosed), asymptomatic at time of diagnosis
- Procedures due as per Gastroenterological Society of Australia surveillance guidelines
- Surveillance requested by previous Endoscopist
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Category 3
Appointment within 365 days |
- No defined category 3 criteria
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Excluded gastrointestinal endoscopy services
Referral to public adult gastrointestinal endoscopy (direct access) services is not routinely accepted for the following conditions:
Condition |
Details (where applicable) |
Anaemia not due to iron deficiency |
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Unexplained dyspepsia in absence of alarm symptoms |
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Assessment of extra oesophageal GORD symptoms including choking, coughing, hoarseness, asthma, laryngitis, chronic sore throat, or dental erosions |
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Useful Information for referring practitioners (not exhaustive list)
Last reviewed: 03-10-2023