Through our referral form, we will triage all referrals to determine the urgency of the referral and to screen for patients who are not suitable to undergo their procedures in an out-of-hospital setting due to their comorbidities.
Patients who meet one of the following exclusion criteria are NOT suitable to be seen at GIHC and they should be referred to a gastroenterologist in the hospital setting.
- 1Coronary artery disease with:
- myocardial infarction within 6 months
- unstable angina
- or percutaneous coronary intervention (angioplasty +/- stent) in past 6 months.
- 2Severe COPD or other chronic lung disease (bronchiectasis, cystic fibrosis) meeting the following criteria:
- on home oxygen
- with ICU admission in past year
- on lung transplantation list
- 3Significant valvular heart disease:
- aortic stenosis with angina, syncope or heart failure symptoms
- severe aortic stenosis with significantly reduced valve area (<1cm2)
- previous endocarditis
- complex congenital heart disease
- 4Decompensated cirrhosis with ascites, known varices, or encephalopathy.
- 5Known abdominal aortic aneurysm > 5 cm or awaiting surgery for AAA.
- 6Age > 80 or age > 75 with any of the following: coronary artery disease, COPD, complicated diabetes, renal failure on dialysis.
- 7Non-ambulatory patients.
- 8On anticoagulation (Coumadin, LMW heparin, Danaproid) for reasons where the medication cannot safely be stopped for at least five days.
- 9Endoscopies for the following indications:
- Melena or hematemesis with hemoglobin <100 or requiring transfusion
- Iron deficiency anemia with hemoglobin <80 or requiring transfusion
- Colonic decompression
- Management of esophageal varices
- 10Brittle diabetics; all other insulin-requiring diabetics should be assessed with respect to insulin requirements pre-procedure.
- 12Previous esophageal, duodenal, biliary or colonic stents.
- 13BMI >40
In addition, patients deemed to have endoscopically complicated disease requiring advanced therapeutic management are not managed at GIHC. They should be referred to hospital based endoscopy units. These include individuals requiring:
- (a) endoscopic bougie or balloon dilatation,
- (b) large piecemeal polypectomy or endoscopic mucosal resection,
- (c) management of gastrointestinal bleeding lesions with argon plasma coagulation, and
- (d) surgical management of advanced neoplasia or carcinoma.