Introduction The basic premises built on are: dysphagia is the single most important predictor of neoplasia, most single symptoms however are poorly predictive, although combinations of symptoms, especially in association with abnormal tests, improve reliability in some instances for both cancer and other conditions. By comparison with colon cancer, there are relatively few research-backed Clinical Practice Guidelines (CPG) to be found in the literature. These recommendations are based on synthesis of these Guidelines undertaken by a Working Group of experts. These Notes will help explain each row of the Upper Gastrointestinal Endoscopy Categorisation Guidelines we have developed.

General principles Use of the age 55 years Oesophageal and gastric cancer (OGC) incidence increases with age. Many of the larger studies examining symptoms which predict risk of OGC have used age > 55 years as the threshold. Consistent with this evidence, we have used this age cut-off as part of the criteria in combination with specific symptoms to determine urgency for upper gastrointestinal endoscopy. We recognise that there are different age cut-offs applied in the colonoscopy guidelines. This reflects differences in age-specific risks of different cancers and the age cut-offs used in existing studies that have informed these guidelines. Additional symptoms Combinations of specific symptoms increase the risk of OGC, especially in patients over 55 years. Abnormal blood tests Markers of iron deficiency anaemia or thrombocytosis (raised platelet count) predict risk of OGC. In the presence of a relevant symptom, this increases the risk of OGC.

Indication A: Symptoms and investigation 1. Dysphagia Based on five large studies in primary care, dysphagia is associated with a positive predictive value (PPV) or 5.5% for oesophageal or gastric cancer. It is the strongest single symptom predictor of OGC and warrants Category 1 endoscopy in any adult patient regardless of age (1).

2. Haematemesis/Melaena The majority of patients with haematemesis or melaena present as emergencies and are admitted acutely for inpatient management according to hospital protocols. Some patients with less severe haematemesis or melaena will present a few days after the acute event, often to their GP. Assuming that they are haemodynamically stable and do not have evidence of ongoing acute bleeding, such patients may not require immediate hospital admission. They do require referral for upper gastrointestinal endoscopy and are listed as a Category 1 referral but ideally require more urgent endoscopy than the 30-day limit to identify the possible source of bleeding (2).

Explanatory notes for Upper Gastrointestinal Endoscopy categorisation guidelines for adults 2018

2

Evidence of iron deficiency anemia

Low Hb

Low Ferritin

Microcytosis

Hypochromia

Confirm coeliac disease with OGD and small bowel

biopsy

+ve

-ve

Check coeliac serology (tTG

Ab)

No

Normal

Manage detected condition

Iron replacement.

Investigate further if response

inadequate

No

Yes Yes

Manage detected condition

Normal

Pre-menopausal

woman

Upper GI symptoms

OGD

Yes Yes No

No No Yes

Normal

Colonoscopy or CT

colography and OGD

Family history of colorectal

cancer*

Colonoscopy or

CT colography

No Yes

3. Anaemia and/or Iron deficiency Figure 1 provides a useful flow chart for the assessment of iron-deficiency anaemia, based on guidelines from The British Society of Gastroenterology (3). Anaemia, especially in the context of specific symptoms or age over 55 years is associated with increased risk of OGC (4). It is important to realise that a positive immunochemical faecal occult blood test (iFOBT) is specific to colonic bleeding. A positive iFOBT is therefore not an indication for a UGE.

CT = computed tomography scan GI = gastrointestinal Hb = haemoglobin OGD = oesophagogastroduodenoscopy tTG Ab = tissue transglutaminase antibody

Source: Guidelines for the management of iron deficiency anaemia. Goddard AF, James MW, McIntyre AS, Scott BB. Gut, 2011; 60:1309-1316. doi:10.1136/gut.2010.22887 (3). Figure 1. An abbreviated flow chart of the investigation of iron deficiency anaemia.

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4. Abnormal imaging This refers to any imaging, usually either ultrasound, CT, or MRI with abnormal findings suggestive of OGC. We have not included abnormal findings on clinical examination alone as we assume that imaging would be performed prior to consideration of a UGE.

5. Weight loss, unexplained The definition of ‘unexplained’ weight loss is an important qualifier that requires clinical judgement. One widely accepted definition is: ‘weight loss of at least 5% of the patient’s usual body weight that occurs within the preceding 6 to 12 months, and that is not the expected consequence of treatment of a known illness.’ (5) Weight loss alone is too non-specific but, in combination with specific upper GI symptoms or relevant abnormal blood results is an important predictor of OGC, especially in patients aged 55 years or above.

6. Dyspepsia (≥55 years) and 7. Dyspepsia (any age) There is no universally accepted definition of dyspepsia. It can include a range of symptoms such as upper abdominal pain or discomfort, heartburn, nausea and reflux. There is some potential for ‘double counting’ of some symptom clusters within this guideline and therefore patients being classified as Category 1 who are not at higher risk of OGC. The additional symptoms of weight loss or vomiting, or abnormal blood tests or imaging, in combination with either dyspepsia, reflux or upper abdominal pain, are probably of greater significance than the combination of upper abdominal pain and reflux alone. Several international guidelines now recommend H. pylori testing as part of the initial assessment of patients with dyspepsia (6) (7) (8) (7). See Figure 2 for a flow chart of this test-and-treat approach. Patients with H. pylori-associated dyspepsia which resolves after H. pylori eradication do not require upper gastrointestinal endoscopy. Patients with dyspepsia and known atrophic gastritis, intestinal metaplasia/gastric dysplasia or a family history of an upper GI cancer as at increased risk of OGC. Intestinal metaplasia/gastric dysplasia are associated with higher risk and therefore patients of any age with these conditions and dyspepsia are considered Category 1 (9) (10).

4

Test for H. pylori using a carbon-13 urea breath test or a stool antigen test, or laboratory-based serology where its performance has been locally validated.

Perform re-testing for H. pylori using a carbon-13 urea breath test. (There is currently insufficient evidence to recommend the stool antigen test as a test of eradication.)

Adults with dyspepsia or reflux symptoms have a 2-week washout period before a test for H. pylori if they are receiving proton pump inhibitor therapy.

Do not use office-based serological tests for H. pylori because of their inadequate performance.

+ve

Proton Pump Inhibitor Dose

Esomeprazole 20mg or Lansoprazole 30mg or Omeprazole 20-40mg or Pantoprazole 40mg or Rabeprazole 20mg

with either

amoxicillin and either – clarithromycin or metronidazole (take into account previous exposure to clarithromycin or metronidazole)

i

ii

if allergic to penicillin – clarithromycin and metronidazole

Eradication therapy for 7 days, twice-daily

No endoscopy required

Test for H. pylori

Re-test for H. pylori

Eradication unsuccessful

Eradication successful

Referral to endoscopy if second-line treatment unsuccessful

Eradication therapy for 7 days, twice-daily

Source: Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. NICE Guidelines CG184 (2014 (11). Figure 2. Helicobacter pylori test and treat policy

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8. GORD (recent onset) and 9. GORD (non-responsive) In some guidelines this term is used only for endoscopically defined oesophagitis. However, for the purpose of triage, we have used the broader definition of reflux-type symptoms. We define non-responsive GORD as that in which significant symptoms persist after 6-8 weeks of full dose proton pump inhibitor (PPI) treatment. Upper gastrointestinal endoscopy is not indicated for extra-oesophageal symptoms potentially due to GORD such as choking, persistent cough, chronic sore throat or dental erosions (12) (13) (14).

10. Upper abdominal pain As discussed under Dyspepsia, upper abdominal pain is often considered within the symptom cluster of dyspepsia. Consistent with several other guidelines, the expert consensus group agreed to treat this as a separate symptomatic entity. In many cases, in the absence of additional upper GI symptoms or abnormal blood tests/imaging, we recommend further specialist assessment before determining the need and urgency for upper gastrointestinal endoscopy.

11. Persistent nausea and vomiting There are various definitions of persistent nausea and vomiting. We have applied the definition in several studies which informed the NICE guidelines on Suspected Cancer, namely nausea and/or vomiting for > 2 weeks although recognise the importance of clinical judgment in defining ‘persistent’ (1).

12. Inflammatory bowel disease in adults One CPG recommended a baseline upper gastrointestinal endoscopy (Category 2) in patients with upper GI symptoms (nausea, vomiting or epigastric pain) at the time of diagnosis of inflammatory bowel disease (15).

13. Pernicious anaemia (endoscopically diagnosed) One CPG discussed pernicious anaemia in the context of gastric cancer risk. Patients with suspected pernicious anaemia (i.e. with low B12 levels and antibodies to intrinsic factor or parietal cells) require a diagnostic upper gastrointestinal endoscopy. Patients with known pernicious anaemia (and atrophic gastritis) are at increased risk of gastric cancer and require upper gastrointestinal endoscopy if they develop relevant symptoms (9).

14. Coeliac disease Three CPGs included recommendations regarding coeliac disease. All recommended duodenal biopsy to confirm the diagnosis of coeliac disease in patients with positive serology (16) (17) (18). Repeat upper gastrointestinal endoscopy is required in patients with persistent symptoms or serology despite following a gluten-free diet for 12 months.

15. Cirrhosis A UGE is recommended for all patients with a diagnosis of cirrhosis to screen for oesophageal or gastric varices (19). Subsequent surveillance of identified varices is covered below.

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Indication B: Surveillance

16. Barrett’s Oesophagus As recommended by Australian Cancer Council Guidelines (20). These are thoroughly researched (21) and locally developed guidelines that have been accepted into Australian practice.

17. Adenomatous polyposis syndrome There is little information on this condition regarding surveillance, but in those with a documented adenomatous polyposis syndrome, commencing upper gastrointestinal endoscopy screening between 25-30 years of age is recommended (22). Ongoing timing of screening is determined by Spigelman Stage identified at initial and subsequent endoscopy (23).

18. Gastric ulcer It is recommended by NICE Guidelines (16) that patients with gastric ulcer and H. pylori should be offered repeat endoscopy 6-8 weeks after beginning eradication treatment, depending on the size of lesion. We also recommend that any H. pylori negative gastric ulcer should be similarly checked for healing after 6-8 weeks treatment.

19. Eosinophilic Oesophagitis Two CPGs were identified for this indication; one low quality (24), the other moderate quality (25). Both CPGs recommended that endoscopy should be used to diagnose eosinophilic oesophagitis and agreed that endoscopy should be performed following a six week to three month course of PPIs, diet modification or steroids in patients with, or with suspected, oesophageal eosinophilia (24, 25).

20. Severe erosive oesophagitis Three CPGs were included for gastro-oesophageal reflux disease (GORD). Two were very low quality(12, 13) and one was moderate quality (14). All three CPGs recommended that endoscopy be used to reassess patients that have persistent or progressive GORD symptoms following a one to three month therapeutic trial of proton pump inhibitors (PPIs) or medical therapy (12-14). Two CPGs also recommended endoscopy for patients with severe erosive oesophagitis after a two month course of PPIs to assess healing and to rule out underlying Barrett’s oesophagus (13, 14).

21. Gastric dysplasia/intestinal metaplasia Two papers, one high quality (9) and one moderate (10), gave good direction for surveillance of this group of patients. The grade and extent of change being critical in determining a plan. Importantly, any defined lesion needs to be removed, rather than being submitted to a surveillance programme. Following EMR of HGD or Early (T1a) cancer oesophagus or stomach, endoscopic surveillance is recommended 3 monthly for the first year, 6 monthly in the second year, and then yearly thereafter (26).

22. Lynch syndrome Recommended that these patients have baseline UGE between the ages 30-35 years (22) and then, for practical efficiency, annually at the same time as their surveillance colonoscopy.

23. Oesophageal varices Two CPGs of moderate quality were identified in Acute UG Bleeding literature (19, 27) and another of very low quality identified in portal hypertension management. They all have well aligned & specific recommendations, dependant on the Grade of varices found. One CPG recommended a diagnostic upper gastrointestinal endoscopy in patients with suspected cirrhosis who present with

7

acute upper GI bleeding within 12 hours of haemodynamic resolution. This is to check for and treat oesophageal varices. In general, cirrhotic patients without varices should undergo endoscopy at two to three year intervals and those with varices should undergo endoscopy yearly (19, 27). Following successful treatment of varices, surveillance endoscopy should occur after 1 to 3 months to check for and treat recurrent bleeding/varices and every 3 to 12 months thereafter (19, 27).

24. Previous therapeutic procedure Patients following definitive chemoradiation for SCC oesophagus (ESMO guidelines) (28), recommended 3 months after completion of therapy then 3 monthly for the first year, 6 monthly for second year and symptomatically after this time. Patients following oesophagectomy (ESMO Guidelines) (28), no role routine endoscopy but should be performed if nutritional or symptomatic issues Patients following gastrectomy (ESMO Guidelines) (29), no role routine endoscopy but may be used for symptomatic issues or as surveillance in partial gastrectomy where concern of field defect, as per Indications 7. and 21.

INDICATION C & D

Indication C: Therapeutic

25. to 28. These procedures are self-explanatory.

29. Other Can be used by requestor to identify any other procedure.

Indication D: Pre-operative assessment

30. to 31. The timing of these procedures is entirely driven by the Elective Surgical Waiting list categorisation.

INDICATION B

References 1. National Clinical Guideline C. National Institute for Health Care Excellence. Suspected cancer: recognitions and referral. London2015. 2. National Clinical Guideline C. National Institute for Health and Clinical Excellence: Guidance. Acute Upper Gastrointestinal Bleeding: Management. London: Royal College of Physicians (UK) National Clinical Guideline Centre. 2012. 3. Goddard AF, James M W, McIntyre AS, Scott BB. Guidelines for the managerment of iron deficiency anaemia. Gut. 2011;60:7. 4. Stapley S, Peters TJ, Neal RD, Rose PW, Walter FM, Hamilton W. The risk of oesophago- gastric cancer in symptomatic patients in primary care: a large case–control study using electronic records. British Journal of Cancer. 2013;108:6. 5. Wong CJ. Evaluation of unintentional wight loss. BMJ Best Practice. 2018. 6. Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. The American journal of gastroenterology. 2017;112(2):212-39. 7. Malfertheiner P, Megraud F, O'Morain CA, Atherton J, Axon AT, Bazzoli F, et al. Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report. Gut. 2012;61(5):646-64. 8. Sugano K, Tack J, Kuipers EJ, Graham DY, El-Omar EM, Miura S, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015;64(9):1353-67. 9. Evans JA, Chandrasekhara V, Chathadi KV, Decker GA, Early DS, Fisher DA, et al. The role of endoscopy in the management of premalignant and malignant conditions of the stomach. Gastrointestinal endoscopy. 2015;82(1):1-8. 10. Dinis-Ribeiro M, Areia M, de Vries AC, Marcos-Pinto R, Monteiro-Soares M, O'Connor A, et al. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED). Endoscopy. 2012;44(1):74-94. 11. National Clinical Guideline C. National Institute for Health and Clinical Excellence. Guidance. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. CG184. London: Royal College of Physicians, National Clinical Guidelines Centre; 2014. 12. Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS). Commissioning guide: Gastro-oesophageal reflux disease (GORD) 2013 [cited 2017 August 1]. Available from: http://www.augis.org/augis-guidelines/gord-commissioning-guide_published/. 13. Shaheen NJ, Weinberg DS, Denberg TD, Chou R, Qaseem A, Shekelle P. Upper endoscopy for gastroesophageal reflux disease: best practice advice from the clinical guidelines committee of the American College of Physicians. Annals of internal medicine. 2012;157(11):808-16. 14. Muthusamy VR, Lightdale JR, Acosta RD, Chandrasekhara V, Chathadi KV, Eloubeidi MA, et al. The role of endoscopy in the management of GERD. Gastrointestinal endoscopy. 2015;81(6):1305-10. 15. Gastroenterology Society of Australia (GESA). Australian Guidelines for General Practitioners and Physicians Inflammatory Bowel Disease (IBD) 2013 [cited 2017 August]. Available from: http://cart.gesa.org.au/membes/files/Clinical%20Guidelines%20and%20Updates/ Inflammatory_Bowel_Disease_2013.pdf. 16. Internal Clinical Guidelines T. National Institute for Health and Care Excellence: Clinical Guidelines. Coeliac Disease: Recognition, Assessment and Management. London: National Institute for Health and Care Excellence (UK), Copyright (c) 2015 Internal Clinical Guidelines Team.; 2015. 17. Ludvigsson JF, Bai JC, Biagi F, Card TR, Ciacci C, Ciclitira PJ, et al. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut. 2014;63(8):1210-28.

INDICATION B

18. Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA. ACG clinical guidelines: diagnosis and management of celiac disease. The American journal of gastroenterology. 2013;108(5):656-76; quiz 77. 19. Hwang JH, Shergill AK, Acosta RD, Chandrasekhara V, Chathadi KV, Decker GA, et al. The role of endoscopy in the management of variceal hemorrhage. Gastrointestinal endoscopy. 2014;80(2):221-7. 20. Australia CC. Clinical practice guidelines for the diagnosis and management of Barrett's Oesophagus and Early Oesophageal Adenocarcinoma Sydney. Available from: https://wiki.cancer.org/australiawiki/index.php?oldid=113682. 21. Whiteman DC, Appleyard M, Bahin FF, Bobryshev YV, Bourke MJ, Brown I, et al. Australian clinical practice guidelines for the diagnosis and management of Barrett's esophagus and early esophageal adenocarcinoma. Journal of gastroenterology and hepatology. 2015;30(5):804-20. 22. Syngal S, Brand RE, Church JM, Giardiello FM, Hampel HL, Burt RW. ACG clinical guideline: Genetic testing and management of hereditary gastrointestinal cancer syndromes. The American journal of gastroenterology. 2015;110(2):223-62; quiz 63. 23. Groves G, Saunders B, A S, R P. Duodenal cancer in patients with familial adenomatous polyposis (FAP): results of a 10 year prospective study. Gut. 2002;50(5):6. 24. Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA. ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). The American journal of gastroenterology. 2013;108(5):679- 92; quiz 93. 25. Lucendo AJ, Molina-Infante J, Arias A, von Arnim U, Bredenoord AJ, Bussmann C, et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European gastroenterology journal. 2017;5(3):335-58. 26. Network NCC. Esophageal and Esophagogastric junction cancers. National Comprehensive Cancer Network, 2018 May 22 2018. Report No. 27. Tripathi D, Stanley AJ, Hayes PC, Patch D, Millson C, Mehrzad H, et al. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut. 2015. 28. Lordick F, Mariette C, Haustermans K, Obermannova R, D A. Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2016;27(5):7. 29. Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology : official journal of the European Society for Medical Oncology. 2016;27(suppl 5):v38-v49.

Appendix A The explanatory notes defined herein are resultant from a Clinical Practice Guideline literature review that examined upper gastrointestinal endoscopy. The included studies from that review are included below. Noting the numbering sequence below is per that literature review, citations for the these explanatory notes are provided in the earlier ‘References’ section. 1. Stefanidis, D., Richardson, W. et al (2012). 'SAGES guidelines for the surgical treatment of esophageal achalasia'. Surgical endoscopy, 26 (2), 296-311. 2. Vaezi, M. F., Pandolfino, J. E.& Vela, M. F. (2013). 'ACG clinical guideline: diagnosis and management of achalasia'. The American journal of gastroenterology, 108 (8), 1238-49; quiz 50. 3. Evans, J. A., Early, D. S. et al (2012). 'The role of endoscopy in Barrett's esophagus and other premalignant conditions of the esophagus'. Gastrointestinal endoscopy, 76 (6), 1087-94. 4. Fitzgerald, R. C., di Pietro, M. et al (2014). 'British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus'. Gut, 63 (1), 7-42. 5. Shaheen, N. J., Falk, G. W. et al (2016). 'ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus'. The American journal of gastroenterology, 111 (1), 30-50; quiz 1. 6. Whiteman, D. C., Appleyard, M. et al (2015). 'Australian clinical practice guidelines for the diagnosis and management of Barrett's esophagus and early esophageal adenocarcinoma'. Journal of gastroenterology and hepatology, 30 (5), 804-20. 7. National Clinical Guideline, C. National Institute for Health and Clinical Excellence: Guidance. Acute Upper Gastrointestinal Bleeding: Management. London: Royal College of Physicians (UK) National Clinical Guideline Centre.; 2012. 8. Gralnek, I. M., Dumonceau, J. M. et al (2015). 'Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline'. Endoscopy, 47 (10), a1-46. 9. Hwang, J. H., Fisher, D. A. et al (2012). 'The role of endoscopy in the management of acute non-variceal upper GI bleeding'. Gastrointestinal endoscopy, 75 (6), 1132-8. 10. Hwang, J. H., Shergill, A. K. et al (2014). 'The role of endoscopy in the management of variceal hemorrhage'. Gastrointestinal endoscopy, 80 (2), 221-7. 11. Tripathi, D., Stanley, A. J. et al (2015). 'UK guidelines on the management of variceal haemorrhage in cirrhotic patients'. Gut. 12. National Collaborating Centre for, C. National Institute for Health and Care Excellence: Clinical Guidelines. Suspected Cancer: Recognition and Referral. London: National Institute for Health and Care Excellence (UK) Copyright (c) National Collaborating Centre for Cancer.; 2015. 13. Syngal, S., Brand, R. E. et al (2015). 'ACG clinical guideline: Genetic testing and management of hereditary gastrointestinal cancer syndromes'. The American journal of gastroenterology, 110 (2), 223-62; quiz 63. 14. Internal Clinical Guidelines, T. National Institute for Health and Care Excellence: Clinical Guidelines. Coeliac Disease: Recognition, Assessment and Management. London: National Institute for Health and Care Excellence (UK) Copyright (c) 2015 Internal Clinical Guidelines Team.; 2015. 15. Ludvigsson, J. F., Bai, J. C. et al (2014). 'Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology'. Gut, 63 (8), 1210-28. 16. Rubio-Tapia, A., Hill, I. D. et al (2013). 'ACG clinical guidelines: diagnosis and management of celiac disease'. The American journal of gastroenterology, 108 (5), 656-76; quiz 77. 17. Moayyedi, P. M., Lacy, B. E. et al (2017). 'ACG and CAG Clinical Guideline: Management of Dyspepsia'. The American journal of gastroenterology, 112 (7), 988-1013. 18. Shaukat, A., Wang, A. et al (2015). 'The role of endoscopy in dyspepsia'. Gastrointestinal endoscopy, 82 (2), 227-32. 19. Internal Clinical Guidelines, T. National Institute for Health and Care Excellence: Clinical Guidelines. Dyspepsia and Gastro-Oesophageal Reflux Disease: Investigation and Management of Dyspepsia, Symptoms Suggestive of Gastro-Oesophageal Reflux Disease, or Both. London: National Institute for Health and Care Excellence (UK)

Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. © State of Victoria, Department of Health and Human Services August 2018

Copyright (c) National Institute for Health and Care Excellence, 2014.; 2014. 20. Evans, J. A., Chandrasekhara, V. et al (2015). 'The role of endoscopy in the management of premalignant and malignant conditions of the stomach'. Gastrointestinal endoscopy, 82 (1), 1-8. 21. Smyth, E. C., Verheij, M. et al (2016). 'Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up'. Annals of oncology : official journal of the European Society for Medical Oncology, 27 (suppl 5), v38-v49. 22. Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) (2013). Commissioning guide: Gastro-oesophageal reflux disease (GORD). Available from: http://www.augis.org/augis-guidelines/gord-commissioning-guide_published/ [Accessed August 1 2017]. 23. Shaheen, N. J., Weinberg, D. S. et al (2012). 'Upper endoscopy for gastroesophageal reflux disease: best practice advice from the clinical guidelines committee of the American College of Physicians'. Annals of internal medicine, 157 (11), 808-16. 24. Muthusamy, V. R., Lightdale, J. R. et al (2015). 'The role of endoscopy in the management of GERD'. Gastrointestinal endoscopy, 81 (6), 1305-10. 25. Camilleri, M., Parkman, H. P. et al (2013). 'Clinical guideline: management of gastroparesis'. The American journal of gastroenterology, 108 (1), 18-37; quiz 8. 26. Chey, W. D., Leontiadis, G. I. et al (2017). 'ACG Clinical Guideline: Treatment of Helicobacter pylori Infection'. The American journal of gastroenterology, 112 (2), 212-39. 27. Malfertheiner, P., Megraud, F. et al (2012). 'Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report'. Gut, 61 (5), 646-64. 28. Sugano, K., Tack, J. et al (2015). 'Kyoto global consensus report on Helicobacter pylori gastritis'. Gut, 64 (9), 1353-67. 29. Kohn, G. P., Price, R. R. et al (2013). 'Guidelines for the management of hiatal hernia'. Surgical endoscopy, 27 (12), 4409-28. 30. Annese, V., Daperno, M. et al (2013). 'European evidence based consensus for endoscopy in inflammatory bowel disease'. Journal of Crohn's & colitis, 7 (12), 982-1018. 31. Gastroenterology Society of Australia (GESA) (2013). Australian Guidelines for General Practitioners and Physicians Inflammatory Bowel Disease (IBD). Available from: http://cart.gesa.org.au/membes/files/Clinical%20Guidelines%20and%20Updates/Inflammatory_Bowel_Disease_2013.pdf [Accessed August 2017]. 32. Shergill, A. K., Lightdale, J. R. et al (2015). 'The role of endoscopy in inflammatory bowel disease'. Gastrointestinal endoscopy, 81 (5), 1101-21.e1-13. 33. Varghese, T. K., Jr., Hofstetter, W. L. et al (2013). 'The society of thoracic surgeons guidelines on the diagnosis and staging of patients with esophageal cancer'. The Annals of thoracic surgery, 96 (1), 346-56. 34. Dellon, E. S., Gonsalves, N. et al (2013). 'ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE)'. The American journal of gastroenterology, 108 (5), 679-92; quiz 93. 35. Lucendo, A. J., Molina-Infante, J. et al (2017). 'Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults'. United European gastroenterology journal, 5 (3), 335-58. 36. de Franchis, R. (2015). 'Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension'. Journal of hepatology, 63 (3), 743-52. 37. Dinis-Ribeiro, M., Areia, M. et al (2012). 'Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED)'. Endoscopy, 44 (1), 74-94. 38. Early, D. S., Ben-Menachem, T. et al (2012). 'Appropriate use of GI endoscopy'. Gastrointestinal endoscopy, 75 (6), 1127-31. 39. Hunt, R., Quigley, E. et al (2014). 'Coping with common gastrointestinal symptoms in the community: a global perspective on heartburn, constipation, bloating, and abdominal pain/discomfort May 2013'. Journal of clinical gastroenterology, 48 (7), 567-78.

Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. © State of Victoria, Department of Health and Human Services August 2018

40. International Centre for Allied Health Evidence (iCAHE) (2013). iCAHE Guideline Quality Check List. Available from: https://www.unisa.edu.au/Global/Health/Sansom/Documents/iCAHE/iCAHE%20Guideline%20Quality%20Checklist.pdf [Accessed November 20 2017]. 41. Kish, M. A. (2001). 'Guide to development of practice guidelines'. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 32 (6), 851-4. 42. Guyatt, G., Oxman, A. D. et al (2011). 'GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables'. Journal of clinical epidemiology, 64 (4), 383-94. 43. Oxford Centre for Evidence-Based Medicine (2009). 'OCEBM Levels of Evidence Working Group. Levels of Evidence 1.'. 44. Oxford Centre for Evidence-Based Medicine (2011). OCEBM Levels of Evidence Working Group. The Oxford Levels of Evidence 2. Available from: http://www.cebm.net/blog/2016/05/01/ocebm-levels-of-evidence/ [Accessed 45. Agency for Health Care Policy and Research Publications (1992). Acute pain management: operative or medical procedures and trauma., US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research., Rockville, MD 46. Mason, J.& Eccles, M. (2003). Guideline Recommendation and Evidence Grading (GREG): a new grading method for Clinical Guideline Development Groups, Centre for Health Services Research: University of Newcastle upon Tyne. Report No.: 109