Introduction For patients referred with suspected upper gastrointestinal (UGI) cancer under the 2 week-wait (2WW), it has been shown that 10.5% will have endoscopic evidence of malignancy, whilst 6.5% of patients may harbour malignancy elsewhere.1 For those patients with weight loss, a negative gastroscopy for cancer poses an important clinical question for the endoscopist. There are no consensus guidelines advising the most appropriate ‘next-step’ the endoscopist should make following patients referred with weight loss but have a negative endoscopy for malignancy.
Aim To evaluate local and national practise in endoscopist decisions when no UGI cancer is found on gastroscopy in 2WW referrals with weight loss.
Methods All 2WW referrals for suspected UGI cancer with weight loss were identified from the 2WW office over a 6 month period at a district general hospital. Endoscopy and imaging results were obtained from the respective computer software packages. Questionnaires were made available to British Society of Gastroenterologists members asking them to reveal their initial management preference at endoscopy in patients referred under the 2WW with weight loss where no upper GI cancer was found.
Results Of the 639 2WW referrals in 6 months, 140 (22%) had weight loss. 6/140 (4%) were found to have either oesophageal or gastric malignancy. 134/140 (96%) did not have cancer, whilst 91 (65%) revealed benign pathologies such as gastritis, duodenitis and hiatus herniae and 43 (31%) were normal. Of the 134 negative endoscopies, the endoscopist took the following actions; 16 (12%) had urgent CT abdomen/chest organised (1 lung malignancy identified), 61 (46%) referred to an urgent Outpatient clinic and 40 (30%) were discharged back to GP. 17 (12%) follow up was to be determined by the list consultant.
71% questionnaire responses received were from consultants. 46% of responders’ preference was to follow up in clinic, 39% organised an urgent CT scan, 18% an ultrasound scan and the rest a brief history to ascertain their preference. 10% discharged the patient back to the GP. 100% of responders had no local guidelines at their trust with regards to this group of patients, whilst 54% felt formal guidelines were warranted.
Conclusion Our study shows a large variation in practise amongst endoscopists and hence the potential to over or under investigate and its consequences. Formal guidelines seem warranted.
Disclosure of Interest None Declared.
Wireko MB, Subramanian V, Ragunath K. The two week WAIT (2WW) referral for upper gastrointestinal cancer: predictors and prevalence of non-upper gastrointestinal cancers in those with negative gastroscopy. Gut 2011; 60:A47