Authors: (including presenting author): :
Han JH (1), Choi YK (1), Cheng LY(1) , Leung WK (1) , Yip WM (2), Leung KW (1)
Affiliation: :
(1) Department of Family Medicine, New Territories East Cluster (2) Department of Medicine, Alice Ho Miu Ling Nethersole Hospital
Keyword 3: :
Family medicine clinic
Keyword 4: :
Oesophagogastroduodenoscopy
Introduction: :
Dyspepsia affects approximately 10-20% of the general population in Hong Kong. Previously, patients were required to undergo multiple assessments at family medicine clinics and then at family medicine triage or specialist outpatient clinics (SOPCs) before an oesophagogastroduodenoscopy (OGD) could be arranged. Stable patients typically waited for over 1 year. To streamline care, the Hospital Authority launched a voluntary pilot scheme at the CGAEH in November 2023. Ambulatory patients aged 18-75 years with epigastric pain or reflux symptoms in stable condition were eligible for a direct access endoscopy service arranged by family medicine doctors. Patients taking anticoagulants or non-aspirin antiplatelet agents, those with active gastrointestinal bleeding, or those under surveillance for polyps, cancer, dysplasia, varices were excluded.
Objectives: :
To evaluate the effectiveness of the CGAEH endoscopy service in reducing OGD waiting times and subsequent referral rates to SOPC.
Methodology: :
This retrospective cross-sectional study included patients referred from Lek Yuen Family Medicine Clinic, NTEC, who underwent OGD at CGAEH between 1 November 2023 and 31 December 2025. Demographic data and OGD findings were retrieved from the clinical management system.
Result & Outcome: :
A total of 164 patients (including 93 patients had regular follow-up for chronic diseases) underwent OGD during the study period, accounting for 168 attendances (2 patients for intestinal metaplasia mapping, 2 for gastric ulcer rescoping). The mean age was 59.4 years, and 72.0% were female. The average waiting time from initial consultation in family medicine clinic to OGD was 48.2 days. Major OGD findings included Helicobacter pylori (n=36), intestinal metaplasia (n=29), Barrett’s oesophagus (n=4), gastric ulcer (n=2), duodenal ulcer (n=5), and polyposis (n=3). Early follow-up visits at the family medicine clinic were arranged to review OGD findings. Patients with H. pylori infection received triple therapy, while those with Barrett’s oesophagus were prescribed a proton pump inhibitor. Of 71 patients presenting with dyspepsia during episodic visits, 66 (93.0%) were discharged after an average of 2.14 visits. Only 25 patients (15.2%) required SOPC referral for earlier intervention and management. The direct access OGD service at CGAEH significantly reduced the waiting time for stable patients to under 7 weeks. By managing the majority of patients (84.8%) within the primary care setting, this new service model effectively alleviates the burden on public specialist service.
