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Introduction Upper gastrointestinal (UGI) cancer two week wait (2WW) referrals have risen substantially in the last decade, with an increasing number of younger patients being referred in the UK. NICE guidance recommends 2WW referral for patients with dysphagia, or for those aged ≥55 years presenting with weight loss and alarm symptoms. However, recent National Endoscopy Database analysis suggests that gastroscopy (OGD) in patients <50 has a low diagnostic yield and that most symptoms (excluding dysphagia) show a weak association with malignancy. This study evaluates the outcomes of 2WW UGI referrals in patients ≤40 years, aiming to investigate the diagnostic yield and value of 2WW investigations in this low-risk population.Methods This was a retrospective single centre study of patients ≤40 years referred via the 2WW UGI pathway. Data was collected for a 12-month period (August 2024 – July 2025) at Barnet & Chase Farm Hospitals, Royal Free London NHS Trust. Data extracted included presenting symptoms, imaging results, OGD and histology findings.Results 207 patients aged ≤40 were referred, accounting for 9.1% of all referrals in the 12-month period. The mean age was 33.3 years. No patients were diagnosed with malignancy. The most common symptoms were abdominal pain (49.3%), dysphagia (41.1%), dyspepsia (35.7%), weight loss (35.3%), and nausea and vomiting (29.5%). 35 patients were referred following abnormalities detected on imaging. A total of 156 OGDs were performed, of which 39.7% were normal, and the remaining cases showed benign pathology. Among the positive findings, gastritis was the most common (34.6%), followed by hiatus hernia (20.5%) and oesophagitis (12.2%). Helicobacter pylori infection was identified in 12.2% of patients. Less common findings included peptic ulcers (3.2%), eosinophilic oesophagitis (2.6%), coeliac disease, benign oesophageal stricture, Barrett’s oesophagus, and atrophic gastritis (each 0.6%). Imaging performed included CT in 63 patients, MRI in 31, and ultrasound in 40, with all investigations showing normal or benign findings. In the 12 months, no cancers were picked up via the 2WW pathway. However, in our review of UGI cancers diagnosed over a 3-year period, 2.4% of cancers diagnosed were in patients <40.Conclusions This retrospective study demonstrates the 55-age cut off for 2WW referrals to be appropriate and supports the selective use of this pathway for ruling out cancer. Alternative pathways to investigate symptoms in younger patients could ensure more efficient use of resources.References National Institute for Health and Care Excellence (NICE). Suspected cancer: recognition and referral (Guideline NG12).Beaton DR, Sharp L, Lu L, et al. Diagnostic yield from symptomatic gastroscopy in the UK: British Society of gastroenterology analysis using data from the national endoscopy database. Gut 2024;73:1421–1430.Abstract P299 Figure 1Pie chart 1