Gastroenterology  |  Elective Services




Gastroenterology

Elective Services

Gastroenterology referrals are prioritised by Senior Medical Officers based on the information contained within. Additional information should be attached where available. The priorisation tool used to triage referrals can be found below under Access Criteria.

All accepted referrals will be seen within a maximum waiting time of 4 months, unless there is a clinical reason for delay.

Referral acceptance is a follows:

First Specialist Assessments:

Waiting priority 1

Accepted

Waiting priority 2

Accepted

Waiting priority 2A

Declined

Waiting priority 2B

Declined

Waiting priority 3

Declined


At First Specialist Assessment (FSA), patients are assessed by a specialist and if surgery is required, patients are then prioritised using the National Gastroenterology CPAC tool.  A 0-100 score is allocated to each patient.

Prior to acceptance for surgery, patients are assessed in Anaesthetic preassessment clinic to ensure they are fit for surgery.

All patients accepted for surgery will be treated within a maximum waiting time of 4 months, unless there is a clinical reason for delay.

Endoscopy List (Surgical/Medical) includes Colonoscopy, Gastroscopy and Sigmoidoscopy

Surgery acceptance is as follows:

Tauranga/Whakatane Endoscopy List:

Waiting priority 1

Accepted

Waiting priority 2

Accepted

Waiting priority 2A

Accepted

Waiting priority 2B

Declined

Waiting priority 3

Declined

 

Access Criteria: Lower Endoscopy:

Category

Criteria

Examples

(not an exhaustive list)

Recommendations

Immediate Assessment

(Requires admission to an acute facility as soon as possible)

  • Acute lower gastrointestinal haemorrhage
  • Change in bowel habit

Colonoscopy

  • Continuous haemorrhage / unstable /> 4 units of blood or stable / requiring blood transfusion
  • Pseudo obstruction

Refer to Hospital

for admission

1 - Urgent

  • Acute lower gastrointestinal haemorrhage
  • Abnormal barium enema/CT Colography

Colonoscopy

  • Acute lower GI bleed stable/not requiring blood transfusion
  • Abnormal barium enema/oral, suspected cancer/polyp >2cm

Refer for Assessment Using CRC Pathway

2 - Semi Urgent

New referrals to the department with established diagnosis, requiring gastroenterology review to prevent clinical deterioration and/or admission

 

2 A -

Semi Urgent

 

  • Chronic rectal bleeding
  • Change of bowel habit
  • Chronic rectal bleeding
  • Iron deficient anaemia
  • Abnormal barium enema

Colonoscopy

  • Chronic rectal bleeding, altered bowel habit/'alarm' symptoms/ > 50 yrs with 'alarm' symptoms
  • Iron deficient anaemia with no leading GI symptoms
  • Chronic rectal bleeding, with no change in bowel habit or 'alarm' symptoms
  • Altered bowel habit / no 'alarm' symptoms
    • Change in bowel habit, without 'alarm' symptoms/recent onset

Via CRC Pathway

2B -

Semi Urgent

 

Colonoscopy

Refer for Assessment

Via CRC Pathway

3 - Routine

 

Colonoscopy

  • Surveillance - personal or family history of colon cancer, ulcerative colitis as per NZ guidelines

Refer for Assessment

 


Upper Endoscopy:

Category

Criteria

Examples

(not an exhaustive list)

Recommendation

Immediate Assessment

(Requires admission to an acute facility as soon as possible)

  • Upper gastrointestinal haemorrhage
  • Foreign Body

 

 

Gastroscopy

  • Upper GI haemorrhage - continuous or early re-bleeding/unstable, or >65 yrs and on NSAID, or chronic liver disease, or stable. haemoglobin <100g/L or stable. minor episode
  • Foreign Body
  • Dysphagia, food bolus obstruction

Refer to Hospital

for admission

1 - Urgent

  • Upper gastrointestinal haemorrhage
  • Dysphagia

Gastroscopy

  • Upper gastrointestinal haemorrhage, >65 yrs and on NSAID
  • Dysphagia: < 3 months, progressive

Refer for Assessment

 

2 - Semi Urgent

New referrals to the department with established diagnosis, requiring gastroenterology review to prevent clinical deterioration and/or admission

 

2 A - Semi Urgent

 

  • Dysphagia
  • Dyspepsia
  • Diarrhoea / suspected IBD

Gastroscopy

  • Diarrhoea / suspected IBD
  • Change in bowel habit, recent onset / with 'alarm' symptoms
  • Positive Coeliac serology
  • 1-2 cm polyps
    • Dysphagia - < 3 months, stable, > 3 months stable, longstanding, intermittent
    • Dyspepsia > 50 yrs with 'alarm' symptoms

Refer for Assessment

2B - Semi Urgent

 

  • Change of bowel habit
  • Dyspepsia / heartburn

 

 

Gastroscopy

  • Dyspepsia, with no 'alarm' symptoms

 

CRC Pathway

Refer for Assessment

However suggest Barium studies if patients can not be seen. 

For diarrhoea, recommend faecal calprotectin,CRP, Stoll MC&S

3 - Routine

 

  • Chronic rectal bleeding
  • Surveillance

Gastroscopy

  • Surveillance - Barrett's (as directed by Gastroenterologist)
  • Functional GI disorders

 

Refer for Assessment



Last updated : Tuesday, September 29, 2015
Next review date : Wednesday, September 28,2016


Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.