Changes to endoscopy pathways at ULHT
At the beginning of the pandemic endoscopy services at ULHT were put on hold with only the most urgent cases undertaken. Since then a recovery programme has been in place that has been recognised nationally as a resounding success. As part of that recovery a number of pathways have been reviewed and changes have had to be made in consultation with Primary Care colleagues to reduce the sizeable backlogs and maintain a good quality service. These changes have been made in response to new guidance and an ever increasing demand for endoscopy services. The two pathways that have changed are direct access and the 2ww lower GI pathway. Further details on the individual pathways can be found below.
Direct Access
Direct or Open Access has closed to endoscopy. All current direct access referrals have been vetted and a sizeable number will be removed from the waiting list. Letters identifying those patients will be sent out to the relevant GP practices and patients also informed.
Why has direct access been switched off?
The vast majority of endoscopies undertaken via direct access are normal.
Pathological findings are low and in those, the majority have alarming symptoms and would have benefitted from being referred on an urgent alternative pathway.
NICE Guidelines for dyspepsia recommend lifestyle changes, medication review and appropriate use of acid suppressing medications etc.
NICE states a lack of value in pursuing endoscopy for acid reflux etc.
The majority of referrals received have not followed NICE guidelines before referring the patient.
What should you do when you cannot make a direct access referral?
Review any previous endoscopy results for the patient.
Follow NICE guidance around lifestyle changes, medication review and appropriate use of suppressing medications etc.
Utilise the Advice & Guidance service at ULHT.
Lower GI pathway
At the beginning of the COVID outbreak only the most urgent cases on a lower GI 2ww pathway underwent a colonoscopy. A number of changes were put in place to prioritise and triage all 2WW patients on a lower GI pathway. All patients already referred into ULHT were asked to undertake a FIT test and those with a FIT <10ug/gm would not require a colonoscopy.
NICE have published recent guidance (updated November 2020) ‘Clinical guide for triaging patients with lower gastrointestinal symptoms’. This guidance recommends the use of a FIT test. It has been agreed regionally and locally that the most appropriate place for the FIT test to be undertaken is in primary care prior to the 2ww referral being submitted to ULHT to ensure the patient faces no delays in being triaged at ULHT.
When and how to make a 2WW referral
Ensure patient meets NG12 guidance for lower GI symptoms.
Order the following tests if not already undertaken: eGFR, Hb, MCV, Ferritin, tissue transglutaminase, and a FIT test.
Submit results and referral utilising the new 2ww Lower GI referral form.
If results are not available when submitting referral form please highlight reason for this on the form.
If patient does not meet NG12 guidance please utilise Advice and Guidance.