Introduction A service review of the upper GI 2 WW referrals locally showed a 20% annual increase in the UGI referrals from 2013 to 2015. The cancer pick up rates were static at 4.5% with the vast majority of patients discharged back to their GP after a normal gastroscopy.1 The review also showed a 43% re-referral rate back to gastroenterology after a normal gastroscopy leading to an increase in the outpatient volumes and hence a delay in the delivery of care to those patients.
Methods We piloted a dedicated consultant taking a lead to vet all UGI referrals and to channel them in to a simple (straight to gastroscopy) or complex (clinic first) pathway. All complex pathway patients were reviewed in clinic and investigated appropriately if required.
Results Of the 619 UGI 2 WW referrals received over a 3 month period between August to October 2015, 153 (25%) patients were reviewed in dedicated complex pathway clinics (2 clinics/week). The cancer pick up rate increased to 8% (12) with 60% (7) being UGI (oesophagus (6) and stomach (1)) and 40% Non-GI cancers (ovarian, lung and endometrial cancers). 15% of these patients had a diagnosis requiring ongoing secondary care follow up (more than one follow up appointment) for conditions such as strictures, coeliac disease and eosinophilic oesophagitis etc. 42% (65) had a clinically significant diagnosis that required advice and guidance to GP for community follow up. 82% were discharged back to primary care after one follow up appointment.
Conclusion There was an 80% increase in the cancer pick up rate as compared to our previous direct to test pathway. We believe daily clinician vetting of referrals and upgrading to a clinic first pathway contributed to a higher rate of cancer detection. There were non GI cancers detected which would have been missed with a gastroscopy only service. The prompt clinic follow up in secondary care for patients with significant yet benign diagnoses together with advice and reassurance prior to discharge for others should eventually lead to a reduction in the re-referral rate whilst maintaining the high quality delivery of care.
Reference 1 Kapoor N, Bassi A, Sturgess R, et al. Predictive value of alarm features in a rapid access upper gastrointestinal cancer service. Gut 2005;54:40–5.
Disclosure of Interest None Declared