Gastroenterology, Hepatology and endoscopy
COVID 19 and Gastroenterology/Endoscopy and Hepatology referrals
In common with most other specialties, we are changing the way we work over the next few months and in particular who we see in outpatient clinics.
GASTROENTEROLOGY – Limiting face-to face contact in outpatients and endoscopy
Endoscopy : Please note – endoscopic procedures are high risk aerosol generating procedures.
All procedures with the exception of emergency endoscopy have been shut down nationally for the next three weeks until reviewed by April 11 2020. We would advise halting all but emergency referrals during this time.
New outpatient referrals
UGI symptoms – Reflux – manage symptomatically without endoscopy
Dyspepsia – emphasise test (Hp) and treat
No routine gastroscopies
IBS/lower GI symptoms FIT or Fcal if diarrhoea and querying IBD
Colonoscopy only in those FIT/Fcal +ve
2ww LGI pathway Rectal Bleeding – STT FS
All others : FIT , only refer for colonic imaging if FIT positive
FU OPD : telephone consultation
Consultant secretary contacts patients in proceeding week confirming time of planned telephone consult (at OPD clinic time)
Only bring up those whose telephone consult is unsatisfactory/relapsing
Gastroscopy
Routine/open access – stop and manage symptomatically
2ww UGI pathway – dysphagia – teleclinic in place to assess severity of dysphagia – barium swallow first before considering OGD ( if pathology on Xray)
Halt surveillance: Barretts, FAP; , Defer for 6 months
EMR site checks: RT to review individual cases
Colonoscopy /FS
RB – STT FS
All other 2ww LGI pathway and all GI referrals: FIT (or Fcal if diarrhoea) and only proceed if positive
Surveillance colonoscopy: cancer FU, polyp FU, IBD, FH CRC – Defer for 6 months
EMR site checks case review – cases will be reviewed by RT
Stents – continue
EMR – defer until non-emergency endoscopy available then continue
PEGS – Continue
Dilatation – defer until non-emergency endoscopy available then continue
Botox – Case note review
Screening
Bowelscope : Stop
FOBT colonoscopy : stop
ERCP – continue – but currently only emergency cases : acute cholangitis or obstructive jaundice
HEPATOLOGY – Limiting face to face contact in outpatients and endoscopy
New outpatient referrals
Asymptomatic abnormal LFTs – Need full CLD screen (including AST to allow FIB-4 score) and abdominal ultrasound in primary care, we will write to GP with precise test requirements, GP to inform us of any abnormalities so that we can advise on further investigation/management
Alcohol misuse – Referrals will be passed to our alcohol & substance misuse team who will advise on management, please note that admissions for alcohol detox will be deferred until the COVID-19 crisis has eased
Unwell patients with abnormal LFTs – These referrals will be reviewed on a case by case basis, most will be offered initial telephone consultation, some will be seen in outpatient clinic, particularly if jaundiced/decompensated cirrhosis
2ww HPB referrals – All need urgent abdominal ultrasound request, will be reviewed on a case by case basis, most will be offered initial telephone consultation, some will be seen in outpatient clinic
FU OPD : telephone consultation
Consultant secretary contacts patients in proceeding week confirming time of planned telephone consult (at OPD clinic time)
Only bring up those whose telephone consult is unsatisfactory/patient unwell (we will try to see these patients within a week of telephone consult)
Surveillance gastroscopy for varices – This will be deferred until the current COVID-19 crisis has eased
Gastroscopy for variceal banding – This is halted at present but planned to continue once non-emergency endoscopy restarts if the patient has had a recent variceal bleed and is in the middle of a banding programme, primary banding cases will be reviewed on a case by case basis.