Gastroenterology Today Autumn 2020

GASTROENTEROLOGY TODAY - AUTUMN 2020
NHS trusts with:
2WW Urgent referrals
Routine referrals
ADVERTORIAL FEATURE
Surveillance cases
Bowel cancer screening services
ENDOSCOPY ALTERNATIVES IN A TIME OF COVID:
NHS Facility NHS Staff NHS
INNOVATIVE THINKING AND DIFFERENT WAYS OF WORKING
processes
TO CLEAR NHS TRUSTS WAITING LISTS
Enhanced sedation (Propofol) lists
Additionally, we can support Direct Access
and Rapid Access endoscopy referrals by
working with the local clinical leads to agree
strong governance for the management of
these patients.
This quarter we explore the potential for Transnasal endoscopy as a
new technological alternative which may assist Trusts in managing
the significant spike in diagnostics demand arising from COVID 19.
Transnasal endoscopy, or TNE, is an upper GI endoscopy method which
is performed by the nasal route (rather than the oral route) using a thin
Criteria & Quality
endoscope less than 6 mm in diameter. This technique has been shown
to improve patient tolerance and is more convenient.
We select Endoscopists with an endoscopy
orientated career path and performance
measures above the national average. JAG
audit data is constantly monitored to ensure
has prevented successful internal review.
ongoing quality. Furthermore, we have a
Sedation is not required during Transnasal endoscopy and therefore
clinical governance department that is crucial
to maintaining quality and safety but also
provides support to both Endoscopists and
ensuring diagnostics continue while, importantly, being separated
the from units COVID within red zones. which Recovery we times work. are short and the patient is
Unsedated conventional oral gastroscopy (c-OGD) commonly causes
gagging, retching and nausea which are avoided with TNE due to limited
stimulation of the tongue and soft palate, thus saving treatment time and
occasional repeat patient visits where physical rejection of the camera
nursing staff will not be required for monitoring patient vital signs, offering
an immediate cost-saving. The procedure can furthermore be carried
out in an outpatient setting with a smaller estates footprint, importantly
able to leave the room and hospital immediately once the procedure
is completed and without the need for further monitoring or recovery
We provide tailored solutions to manage
capacity from straight forward supply of staff
to a team based managed solution to a full
patient pathway including pathology review.
facilities (Gorelick et al. 2001). There are a number of cost analyses
clearly demonstrating the cost savings for TNE (Wellenstein et al. 2019;
Anon n.d.; Atar and Kadayifci 2014), and these come from a combination
of decreasing the cost and total duration of endoscopic procedures,
increased capacity and reduced staff requirements and all while allowing
deployment in safe, manageable outpatient settings.
Accuracy of Diagnosis
Our commitment to improving the
NHS experience
conventional endoscopes, thus maintaining the diagnostic accuracy.
Like Current the data NHS suggests Trusts that TNE we has work better with, patient tolerance patient when
care is at the centre of everything we do. By
using any spare weekend capacity within a
Trust, the 18 Week Support insourcing teams
Training & Deployment
are able to see a high volume of patients
in a short space of time, in the familiar
surrounding of the NHS Trust.
To date, data suggests that there is preservation of the image quality of
compared to unsedated endoscopy (Garcia et al. 2003; Parker et al. 2016;
Schuldt et al. 2019). Nasal pain is the most significant symptom associated
with endoscopic procedures but can be reduced with nasal pre-treatment.
Transnasal endoscopes are very similar to standard or slim endoscopes
except for their outer diameter, which is usually less than 6 mm, and a
smaller working channel, of only 2 mm in diameter. The disadvantage
of this smaller calibre working channel is that only specialist paediatric
biopsy forceps can be used to take tissue samples. There is the risk that
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that’s financially accountable and financially
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rooms is not required.
We’re committed to the NHS
14and the delivery of high-quality care, and to
helping Trusts reduce RTT waiting times.
histological analysis may be impaired with smaller tissue samples.
Implementation of TNE requires procurement of the endoscopes and if
necessary a dedicated processor. The fact that these procedures can
be carried out in outpatient settings means that refurbishing hospital
Clinical team
There is no formal training program for TNE, but all endoscopists
undertaking Trans-nasal endoscopy procedures must have JAG
certification for diagnostic UGI endoscopy (oral route). However, there
is a requirement to understand the nasal anatomy and how to deal with
complications. There are also subtle differences to the techniques required
to negotiate some aspects of the anatomy, particularly large hiatus hernias
Happy patient
and passage through to D2. There are training courses available, which
JAG strongly recommends clinicians attend. It is recommended that
ENT surgeons should be involved at local service level to understand
the anatomical approach and managing complications, and to provide
mentoring. It is advised that a minimum of 20 full procedures are observed
Who we’re looking for
and competencies met before independent practice.
We are interested in meeting with Consultant
Summary
Gastroenterologists, senior nurses and clinical
nurse specialists throughout the UK.
Transnasal endoscopy offers Trusts considerable advantages and
flexibility during this time of COVID. TNE can be safely and easily
deployed, including in outpatient settings which makes it easy to keep
Our remuneration package is second to
none and is per session rather than per case
which allows our teams to work in a safe and
Bibliography
calm environment’
diagnostic patients separate from COVID red zones; accurate diagnostic
results can be delivered with smaller teams and with reduced impact on
the patient; and special TNE training and deployment needs are limited.
Anon Cost Savings of Transnasal Endoscopy Versus Standard Endosco...: Official
journal of the American College of Gastroenterology | ACG [Online]. Available at:
https://journals.lww.com/ajg/Fulltext/2008/09001/Cost_Savings_of_Transnasal_
Endoscopy_Versus.1037.aspx About you [Accessed: 24 August 2020a].
Atar, M. and Kadayifci, A. 2014. Transnasal endoscopy: Technical considerations,
advantages and limitations. World journal of gastrointestinal endoscopy 6(2), pp. 41–48.
If you have an excellent NHS record and
Garcia, R.T., Cello, J.P., Nguyen, M.H., et al. 2003. Unsedated ultrathin EGD is well
accepted when compared with conventional sedated EGD: a multicenter randomized
trial. want Gastroenterology to help 125(6), clear pp. 1606–1612. NHS waiting list
backlogs, reduce RTT waiting times and
provide high-quality patient care, get in
touch by calling on 020 3966 9081 or email
Gorelick, A.B., Inadomi, J.M. and Barnett, J.L. 2001. Unsedated small-caliber
esophagogastroduodenoscopy (EGD): less expensive and less time-consuming than
conventional EGD. Journal of Clinical Gastroenterology 33(3), pp. 210–214.
Parker, C., Alexandridis, E., Plevris, J., O’Hara, J. and Panter, S. 2016. Transnasal
endoscopy: no gagging no panic! Frontline gastroenterology 7(4), pp. 246–256.
Schuldt, A.-L., Kirsten, H., Tuennemann, J., et al. 2019. Necessity of transnasal
gastroscopy recruitment@18weeksupport.com
in routine diagnostics: a patient-centred requirement analysis. BMJ open
gastroenterology 6(1), p. e000264.
Wellenstein, D.J., Honings, J., Schutte, H.W., et al. 2019. Cost analysis of office-based transnasal
esophagoscopy. European Archives of Oto-Rhino-Laryngology 276(5), pp. 1457–1463.
18 Week Support
www.18weeksupport.com
Dr Matthew Banks Banks
Clinical Lead for Gastroenterology
18 Week Support
London 3rd Floor, 19-21 Great Tower Street, London EC3R 5AR
Birmingham Unit 25, Lichfield Business Village, The Friary WS13 6QG
GASTROENTEROLOGY TODAY - SPRING 2019