If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
acute upper GI tract bleeding
acute severe lower GI tract bleeding
oesophageal foreign bodies/food bolus
Acute Severe Colitis*
Severe vomiting and/or diarrhoea with dehydration
Acute/fulminant liver failure (to be referred to a centre with dedicated hepatology services
Biliary sepsis (to be referred to a centre with ERCP service)
* Acute severe colitis as defined by the Truelove and Witts criteria – all patients with ≥ 6 bloody bowel motions per 24 hours plus at least one of the following:
Australian clinical practice guidelines for the diagnosis and management of Barrett's oesophagus and early oesophageal adenocarcinoma (2015) recommended screening endoscopy schedules
No dysplasia on endoscopic assessment and Seattle protocol biopsy
If there has been previous low-grade dysplasia, see low-grade dysplasia protocol.
Seattle protocol—biopsy of any mucosal irregularity and quadrantic biopsies every 2 cm unless known or suspected dysplasia then quadrantic biopsies every 1 cm.
Indefinite for dysplasia on biopsy
The changes of indefinite for dysplasia on biopsy should be confirmed by a second pathologist, ideally an expert gastrointestinal pathologist. If indefinite for dysplasia is confirmed, then the following endoscopic surveillance is recommended:
Low-grade dysplasia on biopsy
The changes of low-grade dysplasia on biopsy should be confirmed by a second pathologist, ideally an expert gastrointestinal pathologist. If low-grade dysplasia is confirmed, then the following endoscopic surveillance is recommended (or refer to an expert centre for assessment):
High-grade dysplasia or adenocarcinoma on biopsy
Referral to a centre that has integrated expertise in endoscopy, imaging, surgery and histopathology
NB: If a patient who has been fully investigated 2 years prior to referral. Then the referrer and the receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy / colonoscopy procedures
Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.