Direct access endoscopy

• Unexplained upper GI bleeding (haematemesis, melaena)
• Unexplained iron deficiency
• Unexplained recent dyspepsia in patients under 50 with alarm symptoms
• Dysphagia, odynophagia
• Persistent vomiting and weight loss
• Reflux refractory to medical therapy
• Upper abdominal mass or imaging abnormality
• Duodenal biopsy following positive serology in suspected coeliac disease
• Surveillance of Barrett’s oesophagus and gastric intestinal metaplasia

• Rectal bleeding for more than 4 weeks
• Positive FOBT (including the National Bowel Cancer Screening Program), age 45 to 75
• Bloody diarrhoea with negative stool MC&S
• Change in bowel habit for more than 6 weeks with alarm symptoms, at any age
• Change in bowel habit for more than 6 weeks without alarm symptoms, age over 60
• Unexplained iron deficiency anaemia
• After a first episode of proven diverticulitis, to exclude neoplasm
• Abnormal imaging
• Active inflammatory bowel disease where endoscopy is needed to guide management
• Surveillance for past bowel cancer, polyps or inflammatory bowel disease
• Surveillance for a significant family history of bowel cancer

All of the following must apply:

• Overt gastrointestinal bleeding, or recurrent or persistent gastrointestinal bleeding with iron deficiency anaemia not due to coeliac disease (with any menorrhagia considered and managed)
• A gastroscopy and colonoscopy have been performed and have not identified the cause of bleeding
• No more than 2 capsule studies in the preceding 12 months