Item
2.a GI Procedure
text
Code List
2.a GI Procedure
CL Item
Upper endoscopy (1)
CL Item
Capsule endoscopy (2)
CL Item
Push enteroscopy (3)
CL Item
Sigmoidoscopy only (5)
CL Item
Other GI endoscopic procedure (specify) (OT)
Other GI endoscopic procedure specification
Item
If other GI endoscopic procedure, specify:
text
Routine screening study
Item
2.b Reason for GI procedure: [1] Routine screening study
boolean
surveillance for Barrett's esophagus
Item
2.b Reason for GI procedure: [2] Procedure for surveillance for Barrett's esophagus
boolean
surveillance for family history of colorectal cancer
Item
2.b Reason for GI procedure: [3] Procedure for surveillance for family history of colorectal cancer
boolean
blood in stool or evidence of GI bleeding
Item
2.b Reason for GI procedure: [4] Procedure that was prompted by blood in stool or evidence of GI bleeding (upper or lower)
boolean
anemia
Item
2.b Reason for GI procedure: [5] Procedure that was prompted by anemia
boolean
difficulty swallowing
Item
2.b Reason for GI procedure: [6] Procedure that was prompted by difficulty swallowing
boolean
esophageal reflux
Item
2.b Reason for GI procedure: [7] Procedure that was prompted by esophageal reflux
boolean
diarrhoea
Item
2.b Reason for GI procedure: [8] Procedure that was prompted by diarrhoea
boolean
abdominal pain
Item
2.b Reason for GI procedure: [9] Procedure that was prompted by abdominal pain
boolean
Reason for GI procedure unknown
Item
2.b Reason for GI procedure: [UNK] Unknown
boolean
other symptom or finding
Item
2.b Reason for GI procedure: [OT] Procedure that was precipitated by other symptom or finding
boolean
other symptom or finding specification
Item
2.b Reason for GI procedure: If Procedure that was precipitated by other symptom or finding, specify
text
Item
3. Was a cancer identified?
text
Code List
3. Was a cancer identified?
CL Item
No (confirmed by procedure/pathology report) (N)
CL Item
Yes, please complete the cancer/GI neoplasm/polyp form and report as an AE/SAE as appropriate (Y)
Item
4. Was a benign GI polyp(s) (1), a benign GI neoplasms(s) or a neoplasm(s) unable to be determined as benign or malignant identified?
text
Code List
4. Was a benign GI polyp(s) (1), a benign GI neoplasms(s) or a neoplasm(s) unable to be determined as benign or malignant identified?
CL Item
No (confirmed by procedure/pathology report) (N)
CL Item
Yes, please complete the cancer/GI neoplasm/polyp form and report as an AE/SAE as appropriate (Y)
