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PTH-140 Taking Nice Guidelines Further: Straight – To – Test for Dysphagia
  1. GSZ Tun1,
  2. M Shiwani2,
  3. S Anwar2,
  4. A Masri2,
  5. A Shirazi-Nejad1,
  6. N Rezwan1,
  7. D Bullas1,
  8. R Atkinson1,
  9. K Kapur1,
  10. A Soliman1,
  11. V Sathyanarayana1,
  12. E Said1
  1. 1Gastroenterology
  2. 2Upper Gastrointestinal Surgery, Barnsley District General Hospital, Barnsley, UK

Abstract

Introduction Straight-to-test (STT) endoscopy as a 2 week-wait (2 WW) referral pathway for patients with dysphagia has been operable since 1996 in Barnsley Hospital NHS Foundation Trust. It offers a “one stop assessment” as patients has an “on table” consultation and examination and additional investigations can be requested. It allows direct general practitioner referrals with an aim to reduce delays in cancer management. However, it may reduce endoscopy capacity as patients require a longer time slot (1.5 vs 1.0 slot). We reviewed the clinical outcome of this service.

Methods Patients were identified through an electronic database "Endosoft" with retrospective analysis of all STT upper gastrointestinal (UGI) endoscopies performed from November 2014-October 2015. Primary end-point was total diagnostic yield with secondary end-point of clinical outcome.

Results 1192 patients were referred as 2 WW. 398 (33%) of these were STT referrals for dysphagia. 385 proceeded to UGI endoscopy. Ratio of male (M) to female (F) was equal. Mean age in M and F was 63 years (range 26–95 in M and 25–95 in F). Total diagnostic yield is shown in Table 1. Multiple diagnoses co-existed in the same patient.

Abstract PTH-140 Table 1

Total diagnostic yield of STT service

Oesophageal cancer was detected in 6% (18 M, 5 F). Histopathology confirmed adenocarcinoma in 70%, squamous cell carcinoma in 17%, carcinoma in situ in 9% and small cell carcinoma in 4%.

All were referred for Multi-Disciplinary Team discussion and had staging Computed Tomography (CT). 4 patients were referred for surgery. 1 patient received radical radiotherapy. 4 received palliative chemo/radiotherapy. The rest were managed with best supportive care.

Of the non-cancer patients, 12% (42/362) were discharged from endoscopy. From endoscopy, 9 patients had investigations arranged (2 barium swallows, 4 abdominal ultrasound scans, 3 CT abdomens) and 3 patients were referred to Ears, Nose and Throat.

Conclusion The STT pathway for dysphagia in our institution helps in maintaining overall prescribed target time for patients for oesophago-gastric cancer. The diagnostic yield for oesophageal cancer was 6%, which is similar to known rates in patients presenting with dysphagia.1 Other benefits are discharge of patients from endoscopy and expedition of management as investigations and referrals can be made from endoscopy.

Reference 1 Rosenstock AS, Kushnir VM, Patel A, et al. Su1509 Diagnostic yield in the evaluation of Dysphagia. Gastrointestinal Endoscopy. 2011;73:AB287

Disclosure of Interest None Declared

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