The one-stop dyspepsia clinic—an alternative to open-access endoscopy for patients with dyspepsia

Abstract

The most sensitive investigative tool for the upper gastrointestinal tract is endoscopy, and many gastroenterologists offer an open-access endoscopy service to general practitioners. However, for patients with dyspepsia, endoscopy is not always the most appropriate initial investigation, and the one-stop dyspepsia clinic allows for different approaches. We have audited, over one year, the management and outcomes of patients attending a one-stop dyspepsia clinic. All patients seen in the clinic were included, and for those not endoscoped the notes were reviewed one year after the end of the study to check for reattendances and diagnoses originally missed. Patients' and general practitioners' views of the service were assessed by questionnaire. 485 patients were seen, of whom 301 (62%) were endoscoped at first attendance. In 66 patients (14%), endoscopy was deemed inappropriate and only one of these returned subsequently for endoscopy. 118 patients (24%) were symptom-free when seen in the clinic and were asked to telephone for an appointment if and when symptoms recurred; half of these returned and were endoscoped. Oesophagitis and duodenal ulcer were significantly more common in this 'telephone endoscopy' group than in those endoscoped straight from the clinic. Overall, 25% of patients referred were not endoscoped. Important additional diagnoses were made from the clinic consultation. General practitioners and patients valued the system, in particular the telephone endoscopy service. 84% of general practitioners said they would prefer the one-stop dyspepsia clinic to open-access endoscopy.

One stop fertility clinic

“…In conclusion, as for other symptoms such as dyspepsia and menorrhagia (Baskett et al 1996;Rutter et al 1998), the investigation of infertility could be rationalised to a One Stop approach (Gordts et al 2002). Pre-visit blood and semen testing combined with pelvic ultrasound, hysteroscopy and culdoscopy in the outpatient clinic provides a thorough assessment of infertile couples.…”

General practitioner referrals to one-stop clinics for symptoms that could be indicative of cancer: a systematic review of use and clinical outcomes

“…there were no clinics that accepted referrals where there was a general suspicion of cancer. The indications for referral included: seven studies on post-menopausal or abnormal vaginal bleeding (20)(21)(22)(23)(24)(25)(26), six studies on breast symptoms (14,15,(27)(28)(29)(30), three for lower gastrointestinal (GI) symptoms (16,31,32), three for elevated prostate specific antigen (PSA) (17,18,33), three for testicular symptoms (34)(35)(36), two for urological symptoms (37,38), two for dyspepsia (39,40), one for haematuria (19), one for unexplained lymphadenopathy (41), and one for neck lumps (6). When reported, one-stop clinics were held in a hospital setting.…”

“…In another study, 88% of GPs said they were satisfied and would use the one-stop lymph node clinic again (41). In the third study, 91% of GPs rated the clinic as 'good' or 'very good', and 84% said they preferred the one-stop clinic for the management of patients with dyspepsia while only 11% said they preferred direct access endoscopy (40). Finally, one study reported that when patients were reassured by all tests being negative in the usual care multi-stop clinic, they were significantly more likely to have further clinic attendance than those reassured in the one-stop clinic (54.4% versus 44.4%, P = 0.0005) (15).…”

Editorial: unsedated transnasal endoscopy

“…For instance, the majority (94%) of patients referred on the 2-week wait cancer pathway do not have cancer 8 and 25% of patients with dyspepsia do not require gastroscopy. 9 Therefore, open access endoscopy alone may not be adequate while referral to the out-patient clinic is also not ideal, because those patients will likely need a second visit for SOGD (or utilise the over-stretched endoscopy facilities in case of one stop dyspepsia clinics). One solution could be to 'realign' the clinical assessment with the endoscopic test in one visit.…”