Effectiveness of Two Week Rule (TWR) Referral System for Patients with Symptoms of Dysphagia

Category: Upper Gastrointestinal

Background: Guidelines are formulated by Department of Health for General Practitioners (GPs) to identify cases with suspected upper gastrointestinal cancer, with estimated pick up rate of 1:15. In such cases, dysphagia is considered serious symptom and should be referred under TWR.

Aims: To assess effectiveness of TWR referral system for patients with dysphagia.

Methods: Patients referred by GPs in year 2004 with symptoms of dysphagia were studied. Data collected from Endoscribe. Patients were categorized as being referred under TWR and non two week rule (NTWR). Both categories were analyzed together and separately specifically for frequency of cancer

Results: Total number of patients referred with dysphagia were 206 (TWR: 108 and NTWR: 98). Mean age 64 years (TWR 66yrs: NTWR 62yrs). Cancers were detected in 9% (TWR: 12% and NTWR: 5%), benign oesophageal strictures in 14% (TWR: 15% and NTWR: 13%) and 41% had reflux disease (TWR: 42% and NTWR: 40%).

Conclusions: TWR is effective in detecting early cancers in patients with dysphagia. However 28% of cancers were relatively not detected early as these patients were referred under NTWR. Hence to improve early cancer detection rate it's important to appropriately assess dysphagia as a serious symptom with a view to refer them under two week rule.