Quality standard
Quality statement 2: Urgent endoscopy
Quality statement 2: Urgent endoscopy
Quality statement
Adults presenting with dyspepsia or reflux symptoms are referred for urgent direct access endoscopy to take place within 2 weeks if they have dysphagia, or are aged 55 and over with weight loss.
Rationale
There is currently wide geographical variation in referral rates for endoscopy for adults with dyspepsia or reflux symptoms. Although many adults presenting with dyspepsia or reflux symptoms will not need an endoscopy, it is important that those with additional symptoms that indicate a higher risk of oesophagogastric cancer are referred urgently for investigation. Direct access endoscopy will ensure that referrals from primary care to the suspected cancer pathway are focused on people with symptoms of suspected cancer.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that adults presenting with dyspepsia or reflux symptoms are referred for urgent direct access endoscopy to take place within 2 weeks if they have dysphagia, or are aged 55 and over with weight loss.
Data source: Local data collection.
Process
a) Proportion of adults presenting with dyspepsia or reflux symptoms and dysphagia who are referred for urgent direct access endoscopy.
Numerator – the number in the denominator who are referred for urgent direct access endoscopy.
Denominator – the number of adults presenting with dyspepsia or reflux symptoms and dysphagia.
Data source: Local data collection. NHS Digital Hospital Episode Statistics collects data on upper gastrointestinal endoscopies.
b) Proportion of referrals for adults presenting with dyspepsia or reflux symptoms and dysphagia who receive urgent direct access endoscopy within 2 weeks.
Numerator – the number in the denominator who receive endoscopy within 2 weeks.
Denominator – the number of referrals for urgent direct access endoscopy for adults presenting with dyspepsia or reflux symptoms and dysphagia.
Data source: Local data collection. NHS Digital Hospital Episode Statistics collects data on upper gastrointestinal endoscopies.
c) Proportion of adults aged 55 and over presenting with dyspepsia or reflux symptoms and weight loss who are referred for urgent direct access endoscopy.
Numerator – the number in the denominator who are referred for urgent direct access endoscopy.
Denominator – the number of adults aged 55 and over presenting with dyspepsia or reflux symptoms and weight loss.
Data source: Local data collection. NHS Digital Hospital Episode Statistics collects data on upper gastrointestinal endoscopies.
d) Proportion of referrals for adults aged 55 and over presenting with dyspepsia or reflux symptoms and weight loss who receive urgent direct access endoscopy within 2 weeks.
Numerator – the number in the denominator who receive endoscopy within 2 weeks.
Denominator – the number of referrals for urgent direct access endoscopy for adults aged 55 and over presenting with dyspepsia or reflux symptoms and weight loss.
Data source: Local data collection. NHS Digital Hospital Episode Statistics collects data on upper gastrointestinal endoscopies.
Outcome
a) Incidence of oesophagogastric cancer.
Data source: Local data collection. Office for National Statistics Cancer Registration Statistics collects data on the incidence of cancer.
b) Oesophagogastric cancer survival rates.
Data source: Local data collection. Office for National Statistics Geographic patterns of cancer survival in England provide data on 1‑ and 5‑year survival rates.
c) Patient satisfaction with investigation of dyspepsia and reflux symptoms.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (general practices and community healthcare providers) ensure that processes and resources are in place so that adults presenting with dyspepsia or reflux symptoms are referred for urgent direct access endoscopy to take place within 2 weeks if they have dysphagia or are aged 55 and over with weight loss. Endoscopy services should record and report inappropriate urgent direct access referrals for adults with dyspepsia or reflux symptoms.
Healthcare professionals refer adults presenting with dyspepsia or reflux symptoms for urgent direct access endoscopy to take place within 2 weeks if they have dysphagia or are aged 55 and over with weight loss.
Commissioners (clinical commissioning groups and NHS England area teams) ensure that they commission services that refer adults presenting with dyspepsia or reflux symptoms for urgent direct access endoscopy to take place within 2 weeks if they have dysphagia or are aged 55 and over with weight loss. Commissioners should monitor inappropriate urgent direct access referrals for endoscopy for adults with dyspepsia or reflux symptoms as well as investigate particularly low rates of referral.
Adults with indigestion or heartburn will be referred for an endoscopy if they have additional symptoms that need to be investigated, such as pain or difficulty swallowing or weight loss when they are over 55. An endoscopy is a procedure that is sometimes carried out to investigate indigestion symptoms and find out what is causing them. It involves using an endoscope (a narrow, flexible tube with a camera at its tip), to see inside the oesophagus and stomach. The person may be offered sedation before the procedure or given a local anaesthetic to numb the throat. The endoscope is then guided down the person's throat and into their stomach. Not everyone with indigestion or heartburn will need an endoscopy.
Source guidance
Suspected cancer: recognition and referral. NICE guideline NG12 (2015, updated 2021), recommendations 1.2.1 and 1.2.7
Definitions of terms used in this quality statement
Urgent direct access endoscopy
Primary care arranges for an endoscopy to be carried out within 2 weeks and retains clinical responsibility throughout, including acting on the result. [NICE's guideline on suspected cancer]
Equality and diversity considerations
Healthcare professionals should take into account cultural and communication needs when arranging and explaining a referral for direct access endoscopy.
Healthcare professionals should respect an adult's choice to refuse an endoscopy if they consider themselves to be too frail due to age.