Reilly, A.L.; Clark, G.; Horder, E.; Berry, L.; Johnson, E.; Denyer, M
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA116
Academic Journal
In January 2001 the NHS Executive published the guidelines on improving the outcomes in upper Gl cancers. These recommended that patients suspected of having upper Gl cancer should be seen within 2 weeks. Referral criteria were agreed by a working group of Gl physicians, surgeons and GPs as follows; unexplained iron deficiency anaemia in patients over 40; progressive dysphagia; jaundice; upper abdominal mass. We report an audit of all patients referred from August 2000 to July 2001 with respect to 1) compliance with the 2 week rule; 2) clinical outcomes. Method: All patients referred urgently with suspected UGI cancer were included in the audit. The sample was collected via the 2 week wait office, outpatient administration departments and endoscopy databases. 81 patients were identified, 2 were excluded due to their failure to attend initial appointment. Results: The compliance with the 2 week standard was 78% (range 1-60 days). Of the patients diagnosed with cancer 8 were referred on the 2 week proforma, 18 via GP letter, 3 via open access and 1 was an inter consultant transfer. Of the 79 patients included in the audit 30 were diagnosed with UGI cancer, of these 22 were referred with dysphagia, 5 with dyspepsia and 3 with anaemia. The breakdown of cancer diagnoses was 19 oesophageal; (14 adenocarcinoma, 2 squamous, 3 undefined); 2 cardia; 9 gastric. 8 patients out of the 79 were undiagnosed because they DNAed endoscopy and 2 patients refused treatment after diagnosis. 12 months after completion of the audit 21 of the 30 cancer patients had died. Conclusion: 51% of all referrals did not have cancer; dysphagia was the only strongly predictive of cancer; early referral appeared not to result in improved clinical outcome.


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