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Planned Care Services

Gastroenterology

Referral Acceptance

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 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 3

Declined

 

Access Criteria

Gastroenterology

National Access Criteria for First Assessment (ACA) Bay of Plenty Variation (Jan 2023)

Category Criteria Examples (not an exhaustive list) Recommendation

Immediate Assessment

(Requires admission to an acute facility as soon as possible)
  • Acute liver failure
  • Acute severe colitis

 

 
  • Acute hepatitis, with raised INR
  • Alcoholic Hepatitis
  • Cirrhosis with decompensation

Refer to Hospital for admission

1 –

Urgent
  • Acute severe hepatitis not requiring admission.
  • Suspected hepatoma

 

  • Acute Hepatitis B
  • Alcoholic hepatitis

Refer with electronic referral form

 

2 - Semi Urgent

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

Refer with electronic referral form

3 –

Semi Urgent
  • Mildly deranged liver function
  • Functional gut disorders with no red flags, and/or raised calprotectin

Note- marginally raised calprotectin up to 150 has little diagnostic value and may not reach threshold for review.

NAFLD is very common.  Weight loss is essential.  Referral will get an advice letter for initial community management (and will be available on the web).

Refer with electronic referral form.  Currently not being accepted.

 

4 -
Routine
  • Chronic abdominal symptoms.

 
  • Constipation, stable IBS symptoms

 

Not accepted

 

 

Weight loss as a lone symptoms should be referred to general medicine

-Abdominal mass (not associated with a specific organ should be referred to the surgeons)

 

 

Lower Endoscopy

Category Criteria Examples (not an exhaustive list) Recommendation
Immediate Assessment (Requires admission to an acute facility as soon as possible)

 
  • Acute lower gastrointestinal haemorrhage
  • Acute change in bowel habit with pain indicative of obstruction
 Colonoscopy
  • Continuous haemorrhage/unstable />4 units of blood or stable / requiring blood transfusion
  • Pseudo obstruction / obstruction

 

1 –

Urgent (14 days
  • Known or suspected CRC (on imaging, or palpable, or visible on rectal examination), for pre-operative procedure to rule out synchronous pathology

  • Unexplained rectal bleeding (benign anal causes treated or excluded) with iron deficiency anaemia (haemoglobin below the local reference range)

  • Altered bowel habit (looser and/or more frequent) > six weeks duration plus unexplained rectal bleeding (benign anal causes treated or excluded) aged ≥50 years
  

Refer with electronic referral form.

 

2 – Semi Urgent

(Six Weeks)
  • Altered bowel habit (looser and/or more frequent) > six weeks’ duration, aged ≥50 years

  • Altered bowel habit (looser and/or more frequent) > six weeks’ duration plus unexplained rectal bleeding

  • (benign anal causes treated or excluded), aged 40–50 years

  • Unexplained rectal bleeding (benign anal causes treated or excluded) aged ≥50 years

  • Unexplained iron deficiency anaemia (haemoglobin below local reference range) (see Comments for Services section items 1 and 2)

  • New Zealand Guidelines Group (NZGG) Category 2 family history plus one or more of altered bowel habit (looser and/or more frequent) > six weeks’ duration plus unexplained rectal bleeding (benign and anal causes treated or excluded), aged ≥40 years

  • NZGG Category 3 family history plus one or more of altered bowel habit (looser and/or more frequent) > six weeks’ duration plus unexplained rectal bleeding (benign and anal causes treated or excluded), aged ≥25 years

  • Suspected/assessment inflammatory bowel disease (consider FSA)

  • Imaging reveals polyp >5 mm
  

Refer with electronic referral form.

3

Routine

(Decline)
  • Acute diarrhoea < six weeks’ duration – likely infectious aetiology and self-limited

  • Rectal bleeding aged less than 50 years (normal haemoglobin) – consider FSA or flexible sigmoidoscopy if no anal cause

  • Irritable bowel syndrome (may require specialist assessment)

  • Constipation as a single symptom

  • Uncomplicated CT-proven diverticulitis without suspicious radiological features

  • Abdominal pain alone without any ‘six-week category’ features

  • Decreased ferritin aged <50 years with normal haemoglobin

  • Abdominal mass – refer for appropriate imaging

  • Metastatic adenocarcinoma unknown primary – 6 percent is due to CRC and in the absence of clinical, radiological, or tumour marker evidence of CRC, colonoscopy is not indicated
  

Refer with electronic referral form.  Currently not being accepted.

Surveillance
  • Family history of colorectal cancer - category 2 and 3 as recommended in the NZ 2012 Guidelines; Category 3 as recommended by the NZ Familial Gastrointestinal Cancer Service or a bowel cancer specialist
  • History of low risk adenomas
 Refer to New Zealand guideline: Guidance on surveillance

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