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Gastroscopy (Direct Access) - Adult

Gastroscopy (Direct Access) - Adult

From 27th September 2022 the NEW Direct Access Gastrointestinal Endoscopy Referral Form will apply to all Direct Access Gastrointestinal Endoscopy requests submitted via Central Referral Service for public metropolitan hospitals in WA.
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:

  • Nil

To contact the relevant service, please see HealthPathways: Acute Gastroenterology Assessment

Presenting issues
  • 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
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:
      • Upper GI indication
  • 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
Highly desirable referral information
  • Results of any additional tests that have been undertaken as part of referral decision
  • Results of any previous gastroscopy
Indicative triage category
Indicative triage 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
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
Category 3
Appointment within 365 days
  • No defined category 3 criteria
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
Unexplained dyspepsia in absence of alarm symptoms
Assessment of extra oesophageal GORD symptoms including choking, coughing, hoarseness, asthma, laryngitis, chronic sore throat, or dental erosions
Useful Information for referring practitioners (not exhaustive list)
Last reviewed: 03-10-2023
wa.gov.au