Urgent Referrals for suspected Oesophago-gastric Upper GI Cancer are based on the Scottish Referral Guidelines for Suspected Cancer
Upper GI USOC Referrals are divided into two referral pathways:
- Referrals where Dysphagia is the main presenting symptom. For referrals for this group of patients please see the detailed guidance on the Dysphagia RefHelp page.
- Referrals for patients with unexplained weight loss* (particularly >55 years) with any of the additional symptoms of upper abdominal pain, early satiety, reflux, dyspepsia, nausea and/or vomiting. This page covers this second group of patients.
*The Scottish Referral Guidelines for Suspected Cancer 2025 specifically note that weight loss is “5% or more of body weight or strong clinical suspicion.”
Related guidance for patients where there is an Urgent Suspicion of Cancer can also be found on the following pages:
- Iron Deficiency Anaemia GI page
- GP Access to CT for Suspected Cancer with no clinically obvious primary page
Uncomplicated Dyspepsia (i.e. in the absence of weight loss or other alarm symptoms as noted above, is rarely, if ever, a presenting feature of upper GI Cancer, and not an indication for USOC referral. For advice on how to refer these patients, please see guidance on the Dyspepsia page.
Updated Oct 25 IA, CN, LP & JB
Who to refer:
- Unexplained weight loss**, particularly >55 years, combined any of the following features:
- Upper abdominal pain (particularly if new or worsening)
- Early satiety
- Reflux symptoms
- Dyspepsia
- Nausea and/or vomiting
** Weight loss: Please provide clear documentation of weight loss, when possible, noting actual weights along with total kg lost and/or total % of body weight loss. Specific measurements aid triage.
The Scottish Referral Guidelines for Suspected Cancer 2025 specifically note that weight loss is “5% or more of body weight or strong clinical suspicion.”
Please remember that all patients with dysphagia should be urgently (USoC) referred to upper GI for upper GI endoscopy using the specific Dysphagia referral pathway.
How to refer:
Referral is via SGI Gateway to RIE, SJH and WGH using the GI Upper excl Dysphagia referral pathway:
- RIE >> Gastroenterology – Medical >> LI GI Upper excl Dysphagia (priority USOC)
- SJH >> Gastroenterology – Medical >> LI GI Upper excl Dysphagia (priority USOC)
- WGH >> Gastroenterology – Medical >> LI GI Upper excl Dysphagia (priority USOC)
PLEASE REMEMBER THAT THIS REFERRAL PATHWAY IS USED FOR ALL UPPER GI REFERRALS (excluding Dysphagia) AND SO THE PRIORITY OF USOC NEEDS TO BE SELECTED FOR ALL USOC REFERRALS.
Regardless of the hospital referred to patients may be contacted to offer an appointment at a different site. If there are specific reasons that a patient would not be suitable for this, please make sure this information is included in the referral.
It is helpful if at the time of referral, the referrer informs the patient that they may be offered an appointment at a different site.
What Information should be included:
Protocol Text Tab
The protocol text tab asks a number of specific questions based on the Scottish Cancer Referral Guidelines. The answers to these questions help the Gastrointestinal team to triage referrals appropriately. This is very important for USOC referrals especially.
Questions for all patients
- Age: < 40 years / 40-55 years / > 55 years
- Duration of symptoms: Unknown / < 1 month / 1-3 months / 3-6 months / > 6 months
- Unexplained weight loss (greater than 5% of body weight or strong clinical suspicion) : Yes / No
Questions for patients with unexplained weight loss
- New or worsening upper abdominal pain or discomfort: Yes / No
- Reflux: Yes / No
- Dyspepsia resistant to treatment: Yes / No
- Vomiting: Yes / No
Questions for all patients
- New persistent vomiting for more than 2 weeks: Yes / No
- Epigastric Mass: Yes / No
- Significant Haematemesis: Yes / No
- Melaena: Yes / No
- Current NSAID use: Yes / No
- Fe-deficiency anaemia: Yes / No
- Previous GI investigations: Details to be written into free text box
- Key Information for endoscopy (e.g. anticoagualation, prosthetic heart valve, diabetic on insulin, severe comorbidity): Yes / No (and a request to provide details under the Referral Text Tab)
Information to include in referral under Referral Text Tab
- Further clinical history relevant to referral
- Details of any key information required for endoscopy
- Any information on comorbidities and frailty, including (if appropriate) a Frailty score
- Hoarse voice (consider ENT referral).
- Coexisting iron deficiency anaemia.
- Coughing / choking during or after drinking.
- Progressive dysphagia particularly for solids.
- Regurgitation.
- Details of any GLP-1 prescriptions (medication and timing of use)
PLEASE REMEMBER THAT THIS REFERRAL PATHWAY IS USED FOR ALL UPPER GI REFERRALS (excluding Dysphagia) AND SO THE PRIORITY OF USOC NEEDS TO BE SELECTED FOR ALL USOC REFERRALS.
After Referral
- GI will triage referral, usually to urgent upper endoscopy (USoC) at any of the 5 Lothian sites. Patients may also be offered appointments at the Regional Endoscopy Unit (REU) at QMH, Dunfermline, where NHS Lothian endoscopists also undertake lists.
- For patients who may struggle to tolerate upper endoscopy, or may not be fit enough for this, please give some indication of this in the referral free text
- If a patient might require urgent admission to hospital, please contact (via switchboard) the on-call GI Registrar (ST) at RIE/WGH or on-call medical team at SJH
