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 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) |
|
Colonoscopy
|
Refer to Hospital for admission |
1 – Urgent – Two week category |
|
Colonoscopy Is the appropriate investigation where:
CT Colonography Is the appropriate investigation where the above are not predominant indications or the patient being referred is over 80 years old and/or has significant comorbidities. |
Refer for Assessment Using CRC Pathway |
2 A – Semi Urgent Six week category |
|
“Benign anal causes’ is defined as haemorrhoids, anal fissure, anal fistula, inflammatory bowel disease, radiation proctitis and mucosal or full thickness rectal prolapse. If no benign anal cause is identified or bleeding continues after the treatment of these, benign causes can be excluded. |
Via CRC Pathway |
Grade 2B - Not accepted
|
Metastatic adenocarcinoma unknown primary (6% is due to CRC and in the absence of clinical, radiological., or tumour marker evidence of CRC, colonoscopy is not indicated) |
|
|
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) |
|
Gastroscopy
|
Refer to Hospital for admission |
1 - Urgent |
|
Gastroscopy
|
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
|
|
Gastroscopy
|
Refer for Assessment |
2B - Semi Urgent
|
|
Gastroscopy
|
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
|
|
Gastroscopy
|
Refer for Assessment |